Individual
MR. COLIN KENNETH MANDIGO
Active
Individual
MR. COLIN KENNETH MANDIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801115066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801115066
LARA BOARD OF SOCIAL WORK MASTERS SOCIAL WORKER LICENSE CLINICAL
MI
Enumeration date
06/27/2019
Last updated
07/16/2025
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