MEDICARE: SHEREE NICOLE MANGUM LCMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A18093	NC

General Provider Information

NPI Number	:	1043934276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEREE NICOLE MANGUM LCMHCA

Provider Business Mailing Address
First Line	:	12578 JESSICA PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1579
Country	:	US
Telephone Number	:	336-978-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3719 LATROBE DR STE 850
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4827
Country	:	US
Telephone Number	:	336-978-4205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	10/01/2022

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