Provider Demographics
NPI:1972274264
Name:MANN, CAROLINE E (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:E
Last Name:MANN
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 1:8301 BERRYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2245
Mailing Address - Country:US
Mailing Address - Phone:704-533-0680
Mailing Address - Fax:
Practice Address - Street 1:8301 BERRYBROOK DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-2245
Practice Address - Country:US
Practice Address - Phone:704-533-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist