Provider Demographics
NPI:1215241484
Name:MANSON, MARIA E (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:MANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MER
Other - Middle Name:
Other - Last Name:MANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:5047 89TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-9642
Mailing Address - Country:US
Mailing Address - Phone:360-259-6125
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-259-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60166545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health