Provider Demographics
NPI:1558554196
Name:MAHAN, CELENA MARTINA (LVN, CADC-CAS)
Entity Type:Individual
Prefix:MRS
First Name:CELENA
Middle Name:MARTINA
Last Name:MAHAN
Suffix:
Gender:F
Credentials:LVN, CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W MISSION AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1721
Mailing Address - Country:US
Mailing Address - Phone:760-747-3424
Mailing Address - Fax:760-747-3435
Practice Address - Street 1:125 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1720
Practice Address - Country:US
Practice Address - Phone:760-747-3424
Practice Address - Fax:760-747-3435
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M0411260826101YA0400X
CA239951164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)