Provider Demographics
NPI:1245369339
Name:MANCHESTER, NADINE LOUISE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:LOUISE
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5351
Mailing Address - Country:US
Mailing Address - Phone:517-787-5816
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTH WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-783-5334
Practice Address - Fax:517-783-6064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health