Provider Demographics
NPI:1154947612
Name:MANASSAH, MICHELE
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:MANASSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GOVERNORS DR APT 1021
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9439
Mailing Address - Country:US
Mailing Address - Phone:779-227-8067
Mailing Address - Fax:
Practice Address - Street 1:1600 GOVERNORS DR APT 1021
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9439
Practice Address - Country:US
Practice Address - Phone:779-227-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health