Individual
MARYANNA ELIZABETH MANDERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2637 EASTERN BLVD, MONTGOMERY, AL 36117
(334) 409-9090
(334) 409-9669
Mailing address
2868 ACTON ROAD, BIRMINGHAM, AL 35243
(205) 968-8360
(205) 968-8361
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2878
AL
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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