Provider Demographics
NPI:1689704413
Name:MANDINGO, AMELITA (PHD, RDT, ADS, CHT,)
Entity Type:Individual
Prefix:DR
First Name:AMELITA
Middle Name:
Last Name:MANDINGO
Suffix:
Gender:F
Credentials:PHD, RDT, ADS, CHT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 W MCNICHOLS RD
Mailing Address - Street 2:SUITE B2-B4
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2357
Mailing Address - Country:US
Mailing Address - Phone:313-863-5554
Mailing Address - Fax:313-863-4711
Practice Address - Street 1:11000 W MCNICHOLS RD
Practice Address - Street 2:SUITE B2-B4
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2357
Practice Address - Country:US
Practice Address - Phone:313-863-5554
Practice Address - Fax:313-863-4711
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator