Provider Demographics
NPI:1013638816
Name:MCMAHAN, DEMICKA TRYNE
Entity type:Individual
Prefix:MS
First Name:DEMICKA
Middle Name:TRYNE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CAMERON WAY CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5943
Mailing Address - Country:US
Mailing Address - Phone:336-816-0543
Mailing Address - Fax:
Practice Address - Street 1:193 CAMERON WAY CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5943
Practice Address - Country:US
Practice Address - Phone:336-816-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)