Provider Demographics
NPI:1194378836
Name:MCKINNEY, CANDICE T (LPC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:T
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 CAMPUS COMMONS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1567
Mailing Address - Country:US
Mailing Address - Phone:703-261-9201
Mailing Address - Fax:888-322-5720
Practice Address - Street 1:1875 CAMPUS COMMONS DR STE 210
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1567
Practice Address - Country:US
Practice Address - Phone:703-261-9201
Practice Address - Fax:888-322-5720
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional