Provider Demographics
NPI:1750659694
Name:MCGAHEY, PENNY ANN (AA AOD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:ANN
Last Name:MCGAHEY
Suffix:
Gender:F
Credentials:AA AOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 S DORA ST STE D
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5465
Mailing Address - Country:US
Mailing Address - Phone:707-472-0362
Mailing Address - Fax:707-472-0121
Practice Address - Street 1:564 S DORA ST STE D
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5465
Practice Address - Country:US
Practice Address - Phone:707-472-0362
Practice Address - Fax:707-472-0121
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M1107181751101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)