Provider Demographics
NPI:1548149669
Name:MANDLEY, TRISHA
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:MANDLEY
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 1:111 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23438-9707
Mailing Address - Country:US
Mailing Address - Phone:540-607-0608
Mailing Address - Fax:
Practice Address - Street 1:111 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23438-9707
Practice Address - Country:US
Practice Address - Phone:540-607-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst