Provider Demographics
NPI:1275868184
Name:MANNION, MARIA CAROL
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CAROL
Last Name:MANNION
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:MANNION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1050 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3802
Mailing Address - Country:US
Mailing Address - Phone:909-623-6391
Mailing Address - Fax:909-620-9491
Practice Address - Street 1:1050 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3802
Practice Address - Country:US
Practice Address - Phone:909-623-6391
Practice Address - Fax:909-620-9491
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)