Provider Demographics
NPI:1265944771
Name:MAHON, NIKITA EMILY-MARIE (MS, NCC, CPRP, LPC)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:EMILY-MARIE
Last Name:MAHON
Suffix:
Gender:F
Credentials:MS, NCC, CPRP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BALTIMORE PIKE # 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2850
Mailing Address - Country:US
Mailing Address - Phone:484-326-9691
Mailing Address - Fax:
Practice Address - Street 1:2566 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1743
Practice Address - Country:US
Practice Address - Phone:215-397-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
PAPC013002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional