Healthcare Provider Details

I. General information

NPI: 1700427200
Provider Name (Legal Business Name): MISS DEIRDRE F MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date: 01/16/2020
Reactivation Date: 09/24/2025

III. Provider practice location address

3419 NW EVANGELINE TRWY STE J-4
CARENCRO LA
70520-6241
US

IV. Provider business mailing address

3419 NW EVANGELINE TRWY STE J-4
CARENCRO LA
70520-6241
US

V. Phone/Fax

Practice location:
  • Phone: 504-320-7758
  • Fax:
Mailing address:
  • Phone: 337-458-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-5193
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: