Provider Demographics
NPI:1578448189
Name:MACINA, KADIDJA
Entity type:Individual
Prefix:
First Name:KADIDJA
Middle Name:
Last Name:MACINA
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 1:610 E 13TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-2018
Mailing Address - Country:US
Mailing Address - Phone:240-476-6627
Mailing Address - Fax:
Practice Address - Street 1:20421 ROUTE 19 STE 310
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-7517
Practice Address - Country:US
Practice Address - Phone:724-612-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional