Provider Demographics
NPI:1851645030
Name:MANNING, MABLE ALYSE (IMF81596)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:ALYSE
Last Name:MANNING
Suffix:
Gender:F
Credentials:IMF81596
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 1591
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90308-1591
Mailing Address - Country:US
Mailing Address - Phone:213-309-4482
Mailing Address - Fax:
Practice Address - Street 1:101 N. LABREA AVE. 301
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-412-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF81596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health