Provider Demographics
NPI:1902435068
Name:MANESS, CALYSSA
Entity Type:Individual
Prefix:
First Name:CALYSSA
Middle Name:
Last Name:MANESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 STRATFORD CROSSING DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUILDFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27260
Mailing Address - Country:US
Mailing Address - Phone:336-971-4395
Mailing Address - Fax:
Practice Address - Street 1:5175 OLD CLEMMONS SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27102-2710
Practice Address - Country:US
Practice Address - Phone:704-780-4271
Practice Address - Fax:888-261-6694
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician