Provider Demographics
NPI:1992452825
Name:MCMANUS, JOHN (LCMHCA, LCAS-A, NCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:LCMHCA, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MOUNTAIN IVY LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6190
Mailing Address - Country:US
Mailing Address - Phone:301-538-0696
Mailing Address - Fax:
Practice Address - Street 1:191 MAIN ST W
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-6967
Practice Address - Country:US
Practice Address - Phone:828-898-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25772101YA0400X
NCA15131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)