Provider Demographics
NPI:1770687709
Name:MCGHEE, MARY E (MA, CCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:MA, CCMHC, NCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MCGHEE-PASTERNAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCMHC, NCC
Mailing Address - Street 1:412 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2561
Mailing Address - Country:US
Mailing Address - Phone:540-899-9826
Mailing Address - Fax:540-373-3913
Practice Address - Street 1:412 CHATHAM SQUARE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2561
Practice Address - Country:US
Practice Address - Phone:540-899-9826
Practice Address - Fax:540-373-3913
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000652106H00000X
VA0701001444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5405181Medicaid
VA111891OtherANTHEM BC/BS PROVIDER #
VA228207OtherTRICARE