MEDICARE: CHRISTINA MANGOLD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1174482525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINA MANGOLD INC

Provider Business Mailing Address
First Line	:	1355 13 MILE RD NE
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-8363
Country	:	US
Telephone Number	:	231-729-1384
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 RICHMOND ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2008
Country	:	US
Telephone Number	:	231-729-1384
Fax Number	:	231-729-1384

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA N MANGOLD
Credential	:	MANGOLD
Telephone Number	:	231-729-1384

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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