Provider Demographics
NPI:1427465921
Name:MAHAFFEY, FETIMA T (LPC, BSC)
Entity type:Individual
Prefix:
First Name:FETIMA
Middle Name:T
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:LPC, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CLAIRTON BLVD STE 500-600
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5505
Mailing Address - Country:US
Mailing Address - Phone:412-650-1100
Mailing Address - Fax:412-650-1101
Practice Address - Street 1:810 CLAIRTON BLVD STE 500-600
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5505
Practice Address - Country:US
Practice Address - Phone:412-650-1100
Practice Address - Fax:412-650-1101
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007501101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103675234Medicaid
13509228OtherCAQH