Provider Demographics
NPI:1568676179
Name:MCMAHAN-WONEIS, CELESTINE (PHD, MMQ)
Entity Type:Individual
Prefix:PROF
First Name:CELESTINE
Middle Name:
Last Name:MCMAHAN-WONEIS
Suffix:
Gender:F
Credentials:PHD, MMQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 FARMER ST
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9416
Mailing Address - Country:US
Mailing Address - Phone:831-335-3972
Mailing Address - Fax:
Practice Address - Street 1:264 FARMER ST
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9416
Practice Address - Country:US
Practice Address - Phone:831-335-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor