Provider Demographics
NPI:1700568011
Name:MANGUM, CHRISTINE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MANGUM
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 CHESTNUT BLUFFS LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9170
Mailing Address - Country:US
Mailing Address - Phone:910-584-1632
Mailing Address - Fax:
Practice Address - Street 1:501 EASTOWNE DR STE 220
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6224
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health