Provider Demographics
NPI:1548851967
Name:GARDIPEE, MACY PAWELEK (LPC)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:PAWELEK
Last Name:GARDIPEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:ELAINE
Other - Last Name:PAWELEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11000
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1000
Mailing Address - Country:US
Mailing Address - Phone:210-816-1524
Mailing Address - Fax:
Practice Address - Street 1:1413 MARTHA RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2917
Practice Address - Country:US
Practice Address - Phone:210-816-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2811101YP2500X
TX78295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty