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General NPI Number Information
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NPI Number | 1194133082
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Entity Type | Individual
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Provider Name | LORA JEANETTE MANDERS MA, LLPC, CAADC, PAC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 6869 S OCCIDENTAL RD
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City | TECUMSEH
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State | MI
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Zip | 49286-9784
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Country | US
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Telephone | 517-423-4777
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Fax | 517-423-7257
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Provider Business Mailing Address
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Address Line | 6869 S OCCIDENTAL RD
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City | TECUMSEH
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State | MI
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Zip | 49286-9784
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Country | US
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Telephone | 517-423-4777
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Fax | 517-423-7257
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-02189
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401010851
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008012
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License Number State | MI
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