Provider Demographics
NPI:1073028783
Name:MANDICH, DAVID VICTOR (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VICTOR
Last Name:MANDICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WARRIOR WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-1356
Mailing Address - Country:US
Mailing Address - Phone:304-949-3591
Mailing Address - Fax:304-949-3791
Practice Address - Street 1:1 WARRIOR WAY STE 103
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1356
Practice Address - Country:US
Practice Address - Phone:304-949-3591
Practice Address - Fax:304-949-3791
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist