Desiree Pearl McKinnon, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018859 Issued in NC

Practice address

13120 Angel Oak Drive
Huntersville, NC 28078

Phone

(443) 366-9670

NPI assigned

May 8, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1417646167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 W FRANKLIN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524145",
            "telephone_number": "704-915-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13120 ANGEL OAK DRIVE",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "28078",
            "telephone_number": "443-366-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "DESIREE",
        "middle_name": "PEARL",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018859",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "P018859",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Emmett McGettigan, M.D.
• Christina McGillicuddy, PSYD
• Anna Madden McIntosh, MA-CCC-SLP
• Ashleigh McIntosh, APRN, FNP-C
• Elizabeth Ann McKenzie
• Kelli Ann McLane, PA-C
• Arian McLeod, LCSWA
• Charlotte McManaman, MD
• Kerstin Ann McMillian, MA, LCMHCA
• Tayler Gabrielle Mebane, MS, APRN, FNP-C

• Clinical Social Worker in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.