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NPI Code Detail

MEDICARE: SERGIO MANCILLA

MEDICARE: SERGIO MANCILLA
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
1101YM0800XMental Health CounselorA22192NC

General Provider Information

NPI Number : 1568391829
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERGIO MANCILLA
Provider Business Mailing Address
First Line : 2415 MORGANTON BLVD SW
Second Line :
City : LENOIR
State : NC
Zip : 28645-9691
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2415 MORGANTON BLVD SW
Second Line :
City : LENOIR
State : NC
Zip : 28645-9691
Country : US
Telephone Number : 828-394-5563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2026
Last Update Date : 05/14/2026

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Directions to “ SERGIO MANCILLA ” Practice Location

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