Organization
LIFESPAN COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA SYWULAK MANNINO PH.D. (OWNER)
(215) 355-8812
Entity
Organization
Contact information
Practice address
729 GROVE AVE, SUITE 3, SOUTHAMPTON, PA 18966-6008
(215) 355-8812
(215) 355-0926
Mailing address
729 GROVE AVE, SUITE 3, SOUTHAMPTON, PA 18966-6008
(215) 355-8812
(215) 355-0926
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PA-003501-L
PA
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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