Provider Demographics
NPI:1255302188
Name:MANNIS, JAMES ALEXANDER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:MANNIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10957 MONTONGO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2136
Mailing Address - Country:US
Mailing Address - Phone:858-689-0964
Mailing Address - Fax:
Practice Address - Street 1:140 SYLVESTER RD
Practice Address - Street 2:SARP BLDG 500, RM 601
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS196011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical