Healthcare Provider Details

I. General information

NPI: 1285746909
Provider Name (Legal Business Name): MICHELLE C MANUSZAK LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 WALKER RD
DOVER DE
19904-6600
US

IV. Provider business mailing address

1151 WALKER RD
DOVER DE
19904-6600
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2380
  • Fax: 302-674-1299
Mailing address:
  • Phone: 302-674-2380
  • Fax: 302-674-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000198
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: