Provider Demographics
NPI:1841875838
Name:MANCHESTER, KARRISSA
Entity type:Individual
Prefix:
First Name:KARRISSA
Middle Name:
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18610 HANNA RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3837
Mailing Address - Country:US
Mailing Address - Phone:813-399-7631
Mailing Address - Fax:
Practice Address - Street 1:27551 CASHFORD CIR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6950
Practice Address - Country:US
Practice Address - Phone:813-399-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health