Provider Demographics
NPI:1568752244
Name:MANGER, VERNIE R (LCPC,CAADC,CGP)
Entity Type:Individual
Prefix:MS
First Name:VERNIE
Middle Name:R
Last Name:MANGER
Suffix:
Gender:F
Credentials:LCPC,CAADC,CGP
Other - Prefix:MS
Other - First Name:V.
Other - Middle Name:R
Other - Last Name:MANGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:11309 DISTINCTIVE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9490
Mailing Address - Country:US
Mailing Address - Phone:708-207-1126
Mailing Address - Fax:708-349-1126
Practice Address - Street 1:11309 DISTINCTIVE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9490
Practice Address - Country:US
Practice Address - Phone:708-207-1126
Practice Address - Fax:708-349-1126
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12400101YA0400X
IL180000807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)