Healthcare Provider Details

I. General information

NPI: 1932724812
Provider Name (Legal Business Name): DEMI ROSE MANCINI LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 OREN AVE N STE 203
STILLWATER MN
55082-6379
US

IV. Provider business mailing address

5995 OREN AVE N STE 203
STILLWATER MN
55082-6379
US

V. Phone/Fax

Practice location:
  • Phone: 651-217-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2510
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: