Provider Demographics
NPI:1801120373
Name:MANNING, LINDSEY (MA)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:NEBLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2033 N NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3287
Mailing Address - Country:US
Mailing Address - Phone:407-902-9058
Mailing Address - Fax:
Practice Address - Street 1:804 N WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2709
Practice Address - Country:US
Practice Address - Phone:386-310-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7611101YM0800X
MA101YM0800X
FLMH11260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010877200Medicaid