Provider Demographics
NPI:1023304193
Name:MANIS, DEIDRE A (LSCSW LCAC)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:A
Last Name:MANIS
Suffix:
Gender:F
Credentials:LSCSW LCAC
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW LCAC
Mailing Address - Street 1:271 W 3RD ST STE 600
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1223
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-941-5075
Practice Address - Street 1:635 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3602
Practice Address - Country:US
Practice Address - Phone:316-660-7500
Practice Address - Fax:316-660-1897
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS607101YA0400X
KS8110104100000X
KS43961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker