Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 92 | NC |
NPI | 1083048516 |
---|---|
Provider Name | Dr. Jack Basden Mckinney |
First Address | Raleigh, NC 27607-5407 |
Second Address | Raleigh, NC 27607-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/09/2013 |