Provider Demographics
NPI:1477834117
Name:MCMAHAN, DIANNE H (MED, MDIV, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:H
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MED, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4017
Mailing Address - Country:US
Mailing Address - Phone:864-241-8222
Mailing Address - Fax:
Practice Address - Street 1:111 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4017
Practice Address - Country:US
Practice Address - Phone:864-241-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5150101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral