Provider Demographics
NPI:1609399088
Name:MANNING, DONNA GAIL
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAIL
Last Name:MANNING
Suffix:
Gender:F
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 13219
Mailing Address - Street 2:
Mailing Address - City:COYOTE
Mailing Address - State:CA
Mailing Address - Zip Code:95013-3219
Mailing Address - Country:US
Mailing Address - Phone:408-281-6555
Mailing Address - Fax:408-463-1015
Practice Address - Street 1:1659 SCOTT BLVD STE 30
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4137
Practice Address - Country:US
Practice Address - Phone:408-281-6555
Practice Address - Fax:408-463-1015
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044230517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA044230517OtherCCAPP CERTIFICATION