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General NPI Number Information
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NPI Number | 1033700836
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Entity Type | Organization
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Legal Business Name | MANIFEST FAMILY SERVICES
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 110 STOCKTON ST STE M
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City | STATESVILLE
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State | NC
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Zip | 28677-5253
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Country | US
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Telephone | 980-446-0004
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Fax | 980-446-0004
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Provider Business Mailing Address
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Address Line | PO BOX 1702
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City | STATESVILLE
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State | NC
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Zip | 28687-1702
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Country | US
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Telephone | 980-446-0004
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Fax | 980-446-0004
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MARGUERITE ANNE ALLEN
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Credential | M.DIV
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Telephone | 980-446-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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