Provider Demographics
NPI:1518916493
Name:MANKE, CHARITY (MA, LLP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:MANKE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 COTTAGEVIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2392
Mailing Address - Country:US
Mailing Address - Phone:231-709-4895
Mailing Address - Fax:
Practice Address - Street 1:810 COTTAGEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2392
Practice Address - Country:US
Practice Address - Phone:231-709-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012325103TC1900X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling