Organization
LIFE DANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A MANUEL PSY.D. (PRESIDENT)
(352) 335-1240
Entity
Organization
Contact information
Practice address
6417 NW 37TH DR, GAINESVILLE, FL 32653-0868
(352) 335-1240
Mailing address
6417 NW 37TH DR, GAINESVILLE, FL 32653-0868
(352) 335-1240
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
11/06/2006
Last updated
08/05/2014
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