Provider Demographics
NPI:1750107843
Name:MANNINO, GABRIEL F (CL61334647)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:F
Last Name:MANNINO
Suffix:
Gender:M
Credentials:CL61334647
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8528
Mailing Address - Country:US
Mailing Address - Phone:360-305-6093
Mailing Address - Fax:
Practice Address - Street 1:3830 GRIFFITH AVE STE 324
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8528
Practice Address - Country:US
Practice Address - Phone:360-305-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL61334647101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor