Provider Demographics
NPI:1114746187
Name:MANWARREN, MICHAEL JAMES II
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:MANWARREN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 CRAIG MANOR RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6531
Mailing Address - Country:US
Mailing Address - Phone:704-517-0206
Mailing Address - Fax:
Practice Address - Street 1:236 CRAIG MANOR RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6531
Practice Address - Country:US
Practice Address - Phone:704-517-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician