MEDICARE: PHYLLIS M MANN LSATP, MAC, CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102017	VA

General Provider Information

NPI Number	:	1891029344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS M MANN LSATP, MAC, CSAC

Provider Business Mailing Address
First Line	:	4912 W MARSHALL ST STE C
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3127
Country	:	US
Telephone Number	:	804-313-6767
Fax Number	:	888-214-4776

Provider Business Practice Location Address
First Line	:	4912 W MARSHALL ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3127
Country	:	US
Telephone Number	:	804-313-6767
Fax Number	:	888-214-4776

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	04/17/2026

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