Healthcare Provider Details

I. General information

NPI: 1548149669
Provider Name (Legal Business Name): TRISHA MANDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 TOWN CENTER WAY
HAMPTON VA
23666-1999
US

IV. Provider business mailing address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax: 877-345-4009
Mailing address:
  • Phone: 877-315-8080
  • Fax: 877-345-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: