Healthcare Provider Details

I. General information

NPI: 1275973604
Provider Name (Legal Business Name): GISHAWN A MANCE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 2ND AVE 506-A
SILVER SPRING MD
20910-3355
US

IV. Provider business mailing address

8607 2ND AVE 506-A
SILVER SPRING MD
20910-3355
US

V. Phone/Fax

Practice location:
  • Phone: 201-589-5533
  • Fax:
Mailing address:
  • Phone: 201-589-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04984
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: