Healthcare Provider Details

I. General information

NPI: 1316841414
Provider Name (Legal Business Name): ARIELLE MANGANIELLO PROFESSIONAL CLINICAL COUNSELOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 107
SAN DIEGO CA
92130-2053
US

IV. Provider business mailing address

10244 PASEO DE LINDA
SAN DIEGO CA
92127-2860
US

V. Phone/Fax

Practice location:
  • Phone: 619-839-9422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARIELLE MANGANIELLO
Title or Position: CEO
Credential: LPCC
Phone: 570-617-0071