Provider Demographics
NPI:1093450686
Name:MANCILLAS, DEBBIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:MANCILLAS
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 1:26901 CAMINO DE ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1600
Mailing Address - Country:US
Mailing Address - Phone:714-420-9193
Mailing Address - Fax:
Practice Address - Street 1:7828 HAVEN AVE STE 212
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3049
Practice Address - Country:US
Practice Address - Phone:909-727-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical