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General NPI Number Information
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NPI Number | 1477274652
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Entity Type | Individual
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Provider Name | MARK ALEXANDER MANN JR. LCMHCA
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Gender | Male
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 448 JAKE ALEXANDER BLVD W
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City | SALISBURY
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State | NC
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Zip | 28147-1365
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Country | US
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Telephone | 704-645-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 85 1ST AVE
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City | CHINA GROVE
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State | NC
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Zip | 28023-2312
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Country | US
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Telephone | 704-657-1264
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-28620
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License Number State | NC
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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 | A17718
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License Number State | NC
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