Provider Demographics
NPI:1851913636
Name:MANNON, TAMELA (CDCA)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:MANNON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14761 STATE ROUTE 93 UNIT 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9820
Mailing Address - Country:US
Mailing Address - Phone:740-577-3100
Mailing Address - Fax:
Practice Address - Street 1:14761 STATE ROUTE 93 UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9820
Practice Address - Country:US
Practice Address - Phone:740-577-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH173176101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)