Provider Demographics
NPI:1700427200
Name:MCKINNEY, DEIRDRE F
Entity type:Individual
Prefix:MISS
First Name:DEIRDRE
Middle Name:F
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4074
Mailing Address - Country:US
Mailing Address - Phone:504-320-7758
Mailing Address - Fax:
Practice Address - Street 1:3419 NW EVANGELINE TRWY STE J-4
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:504-320-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2025-09-24
Deactivation Date:2020-01-16
Deactivation Code:
Reactivation Date:2025-09-24
Provider Licenses
StateLicense IDTaxonomies
LALAC-5193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)