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General NPI Number Information
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NPI Number | 1427450105
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Entity Type | Individual
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Provider Name | MICKETTRIC CARY MANN LCSW, MCAP
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 6708 PLANTATION RD STE B3
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City | PENSACOLA
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State | FL
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Zip | 32504-6356
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Country | US
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Telephone | 850-207-7085
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Fax | 850-465-3255
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Provider Business Mailing Address
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Address Line | 6707 PLANTATION RD STE B3
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City | PENSACOLA
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State | FL
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Zip | 32504-6216
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Country | US
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Telephone | 850-207-7085
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Fax | 850-465-3255
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12221
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 12221
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License Number State | FL
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