Provider Demographics
NPI:1538708391
Name:MCMAHAN, CHANDA CONSTANCE (DOCTRINATE, MAT, BAC)
Entity type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:CONSTANCE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:DOCTRINATE, MAT, BAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 AMES ST. N.E.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-322-1905
Mailing Address - Fax:
Practice Address - Street 1:3320 AMES ST. N.E.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-322-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist