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NPI Code Detail

MEDICARE: MS. VANESSA D MANNNIXON LLBSW/CAC-M

MEDICARE: MS. VANESSA D MANNNIXON LLBSW/CAC-M
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
1101YA0400XAddiction (Substance Use Disorder) Counselor381737643MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447374749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VANESSA D MANNNIXON LLBSW/CAC-M
Provider Business Mailing Address
First Line : 31097 WARREN RD APT 108
Second Line :
City : WESTLAND
State : MI
Zip : 48185-2964
Country : US
Telephone Number : 734-261-5106
Fax Number :
Provider Business Practice Location Address
First Line : 3737 LAWTON ST
Second Line :
City : DETROIT
State : MI
Zip : 48208-2500
Country : US
Telephone Number : 313-361-6136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 08/28/2008

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