Doctor Name: | GINA MANIDIS |
NPI Number: | 1548337124 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | PC004309 |
Business Practice Address: | 1 W Main St Fleetwood, PA - 195221323 |
Business Phone Number: | 6109440445 |
Business Fax Number: | |
Mailing Address: | 1 W Main St, FLEETWOOD |
State: | PA |
Postal Code: | 195221323 |
Phone Number: | 6109440445 |
Fax Number: | |
NPI Enumeration Date: | 11/29/2006 |
NPI Last Update Date: | 04/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC004309 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |