Most Relevant Information
Provider Data
| NPI Number: | 1003481805 |
| Provider Name: | CHARLES MANDA PHD |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP1600X |
| Specialty: | Counselor |
| License Number: | 267057 |
Most Important Dates
| Enumeration Date: | 05/24/2021 |
| Last Updated: | 06/05/2023 |
Provider Practice Location
24 REVIS RD
WEST LIBERTY
KY
414727818
Practice Location Phone/Fax
| Phone: | 5024363533 |
| Fax: |
Provider Mailing Location
24 REVIS RD
WEST LIBERTY
KY
414727818
Provider Mailing Phone/Fax
| Phone: | 5024363533 |
| Fax: |