Healthcare Provider Details

I. General information

NPI: 1861109035
Provider Name (Legal Business Name): MANA LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WALKER DR STE 331E
STATE COLLEGE PA
16801-7097
US

IV. Provider business mailing address

270 WALKER DR STE 331E
STATE COLLEGE PA
16801-7097
US

V. Phone/Fax

Practice location:
  • Phone: 814-933-4622
  • Fax: 814-690-1599
Mailing address:
  • Phone: 814-933-4622
  • Fax: 814-690-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HEATHER DICK
Title or Position: OWNER
Credential: LCSW
Phone: 814-933-4622