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General NPI Number Information
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NPI Number | 1174482525
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Entity Type | Organization
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Legal Business Name | CHRISTINA MANGOLD INC
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 601 RICHMOND ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-2008
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Country | US
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Telephone | 231-729-1384
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Fax | 231-729-1384
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Provider Business Mailing Address
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Address Line | 1355 13 MILE RD NE
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City | SPARTA
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State | MI
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Zip | 49345-8363
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Country | US
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Telephone | 231-729-1384
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA N MANGOLD
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Credential | MANGOLD
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Telephone | 231-729-1384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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