Provider Demographics
NPI:1629827662
Name:MANN, PRYSCILLA LYHN GANDIA (LCSW)
Entity type:Individual
Prefix:
First Name:PRYSCILLA LYHN
Middle Name:GANDIA
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PRYSCILLA LYHN
Other - Middle Name:GANDIA
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15542
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92803-5542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4681 TUCANA ST
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3240
Practice Address - Country:US
Practice Address - Phone:831-207-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1205851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical