Doctor Name: | MRS. DONNA BING MANTOOTH |
NPI Number: | 1053443374 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | 3364 |
Business Practice Address: | 55 International Pkwy Adairsville, GA - 30103 |
Business Phone Number: | 8882952974 |
Business Fax Number: | 7707733655 |
Mailing Address: | 2722 Blacks Bluff Rd Sw, ROME |
State: | GA |
Postal Code: | 301614337 |
Phone Number: | 7062954809 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3364 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |