Doctor Name: | MS. TERRY L MANZO |
NPI Number: | 1154546190 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 500 W Hospital Rd French Camp, CA - 95231 |
Business Phone Number: | 2094686208 |
Business Fax Number: | 2094687032 |
Mailing Address: | 1431 N Edison St, STOCKTON |
State: | CA |
Postal Code: | 952031805 |
Phone Number: | 2099339885 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |