Provider Demographics
NPI:1134751985
Name:KINGSLEY, MANDA LEA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MANDA
Middle Name:LEA
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 VOLUNTEER DR STE 121
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3885
Mailing Address - Country:US
Mailing Address - Phone:423-541-4187
Mailing Address - Fax:
Practice Address - Street 1:3917 VOLUNTEER DR STE 121
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3885
Practice Address - Country:US
Practice Address - Phone:423-541-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker