Organization
MANGATA WELLNESS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOLA WHITE PSYD (OWNER)
(503) 917-9623
Entity
Organization
Contact information
Practice address
388 STATE ST STE 704, SALEM, OR 97301-4023
(503) 917-9623
(503) 919-6050
Mailing address
388 STATE ST STE 704, SALEM, OR 97301-4023
(503) 917-9623
(503) 919-6050
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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