Individual
TONY MCKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
3720 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 659-6135
Mailing address
3720 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 659-6135
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2408-A
NC
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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