Provider Demographics
NPI:1194196709
Name:MAYCUMBER, MANDI (CDP, CPC)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:MAYCUMBER
Suffix:
Gender:F
Credentials:CDP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WESTMOOR CT SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5754
Mailing Address - Country:US
Mailing Address - Phone:360-791-0263
Mailing Address - Fax:360-943-0931
Practice Address - Street 1:2708 WESTMOOR CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5754
Practice Address - Country:US
Practice Address - Phone:360-791-0263
Practice Address - Fax:360-943-0931
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60498897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)