Provider Demographics
NPI:1154801512
Name:KNIGHT, MANDIE LEE (CDCA)
Entity type:Individual
Prefix:MRS
First Name:MANDIE
Middle Name:LEE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:MANDIE
Other - Middle Name:LEE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:1195 SULLIVANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1350
Mailing Address - Country:US
Mailing Address - Phone:614-349-1154
Mailing Address - Fax:
Practice Address - Street 1:1195 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1350
Practice Address - Country:US
Practice Address - Phone:614-349-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.167863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator