Provider Demographics
NPI:1598081499
Name:MANDREKY, EVE ROSE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:EVE
Middle Name:ROSE
Last Name:MANDREKY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:EVE
Other - Middle Name:ROSE
Other - Last Name:MANDREKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:2110 E HILL RD APT 23
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5106
Mailing Address - Country:US
Mailing Address - Phone:810-771-4876
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1552
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-7599
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)