Provider Demographics
NPI:1033849641
Name:MANN, ARIEL MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:MICHELLE
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRIARCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2913
Mailing Address - Country:US
Mailing Address - Phone:618-973-0597
Mailing Address - Fax:
Practice Address - Street 1:101 S BELT W
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2503
Practice Address - Country:US
Practice Address - Phone:618-973-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210476851041C0700X
IL149.0245591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical