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General NPI Number Information
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NPI Number | 1053305904
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Entity Type | Individual
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Provider Name | DIANE DONLEY MANKUS MS, NCC, LGPC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8203 HARFORD RD
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City | PARKVILLE
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State | MD
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Zip | 21234-5888
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Country | US
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Telephone | 800-491-5369
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 SOVEREIGN PL
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City | FREDERICK
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State | MD
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Zip | 21703-8381
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Country | US
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Telephone | 301-620-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | LGP114
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License Number State | MD
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