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General NPI Number Information
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NPI Number | 1992452825
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Entity Type | Individual
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Provider Name | JOHN MCMANUS LCMHCA, LCAS-A, NCC
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Gender | Male
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 191 MAIN ST W
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City | BANNER ELK
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State | NC
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Zip | 28604-6967
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Country | US
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Telephone | 828-898-3155
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Fax |
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Provider Business Mailing Address
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Address Line | 166 MOUNTAIN IVY LN
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City | BOONE
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State | NC
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Zip | 28607-6190
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Country | US
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Telephone | 301-538-0696
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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-25772
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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 | A15131
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License Number State | NC
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