Provider Demographics
NPI:1316323348
Name:MANNING, JIM (LISW/CP-AP)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:LISW/CP-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 TWO NOTCH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1454
Mailing Address - Country:US
Mailing Address - Phone:803-779-7257
Mailing Address - Fax:
Practice Address - Street 1:2638 TWO NOTCH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1454
Practice Address - Country:US
Practice Address - Phone:803-779-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC001331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical