Provider Demographics
NPI:1750737391
Name:MANDE' COUNSELING
Entity type:Organization
Organization Name:MANDE' COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:GAMAL
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:413-391-1983
Mailing Address - Street 1:1365 MAIN ST STE 401
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1685
Mailing Address - Country:US
Mailing Address - Phone:877-336-2770
Mailing Address - Fax:
Practice Address - Street 1:1365 MAIN ST SUITE 401
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103
Practice Address - Country:US
Practice Address - Phone:877-336-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41DR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health