Provider Demographics
NPI:1821328550
Name:MANCE-KHOUREY, JANETTE MARIE (PHD)
Entity Type:Individual
Prefix:MS
First Name:JANETTE
Middle Name:MARIE
Last Name:MANCE-KHOUREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 DUKE ST APT 112
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1267
Mailing Address - Country:US
Mailing Address - Phone:330-309-3127
Mailing Address - Fax:
Practice Address - Street 1:321 DUKE ST APT 112
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1267
Practice Address - Country:US
Practice Address - Phone:330-309-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical