Healthcare Provider Details

I. General information

NPI: 1336635002
Provider Name (Legal Business Name): WILLIAM MCKENNA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

IV. Provider business mailing address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-0966
  • Fax: 804-264-1029
Mailing address:
  • Phone: 804-264-0966
  • Fax: 804-264-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: