Provider Demographics
NPI:1124527817
Name:HABERLING-MANSFIELD, JOHANNA (BS, CDP)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:HABERLING-MANSFIELD
Suffix:
Gender:F
Credentials:BS, CDP
Other - Prefix:MS
Other - First Name:JOHANNA
Other - Middle Name:LEE
Other - Last Name:HABERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, CDP
Mailing Address - Street 1:415 N MORAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2667
Mailing Address - Country:US
Mailing Address - Phone:509-735-6900
Mailing Address - Fax:509-735-6914
Practice Address - Street 1:415 N MORAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2667
Practice Address - Country:US
Practice Address - Phone:509-735-6900
Practice Address - Fax:509-735-6914
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003763101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)