Healthcare Provider Details

I. General information

NPI: 1194133082
Provider Name (Legal Business Name): LORA JEANETTE MANDERS MA, LLPC, CAADC, PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
ADRIAN MI
49221-1759
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-1800
  • Fax:
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-850-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401010851
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-02189
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: