Provider Demographics
NPI:1851962351
Name:MANINA, ALYSSA DARLENE
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:DARLENE
Last Name:MANINA
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 1:600 TAYLOR RD APT 91
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2157
Mailing Address - Country:US
Mailing Address - Phone:352-701-8162
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3983
Practice Address - Country:US
Practice Address - Phone:912-445-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician