Provider Demographics
NPI:1548570286
Name:LANDRON, MANUEL
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:LANDRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0074
Mailing Address - Country:US
Mailing Address - Phone:704-819-0666
Mailing Address - Fax:704-819-0666
Practice Address - Street 1:8800 PINNACLE CROSS DR
Practice Address - Street 2:APT 12
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4754
Practice Address - Country:US
Practice Address - Phone:704-819-0666
Practice Address - Fax:704-819-0666
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0062981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical