Provider Demographics
NPI:1891928370
Name:MANNING, ERENA (LPCC)
Entity type:Individual
Prefix:
First Name:ERENA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76A NM 581
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9454
Mailing Address - Country:US
Mailing Address - Phone:512-696-8492
Mailing Address - Fax:
Practice Address - Street 1:1200 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2687
Practice Address - Country:US
Practice Address - Phone:512-696-8492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0209551101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCCMH0209551OtherSTATE OF NEW MEXICO