Provider Demographics
NPI:1609368729
Name:MANNS, DEBORAH K (FOUNDER)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:MANNS
Suffix:
Gender:F
Credentials:FOUNDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 CENTINELA AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-6950
Mailing Address - Country:US
Mailing Address - Phone:323-457-0997
Mailing Address - Fax:888-235-7774
Practice Address - Street 1:2306 W 73RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5342
Practice Address - Country:US
Practice Address - Phone:323-920-6258
Practice Address - Fax:888-235-7774
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health