Provider Demographics
NPI:1912051830
Name:MCMAHON, SANDRA JOHNSON (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JOHNSON
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WALNUT DR.
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367
Mailing Address - Country:US
Mailing Address - Phone:724-941-1615
Mailing Address - Fax:
Practice Address - Street 1:40 12TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3279
Practice Address - Country:US
Practice Address - Phone:304-233-1200
Practice Address - Fax:304-233-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107508OtherCIGNA
466489OtherVALUOPTIONS
342868OtherMANAGED HEALTH NETWORK
OHY584446AOtherHEALTH PLAN
261693OtherCOMPYSCH