Provider Demographics
NPI:1043934276
Name:MANGUM, SHEREE NICOLE (LCMHCA)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:NICOLE
Last Name:MANGUM
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12578 JESSICA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1579
Mailing Address - Country:US
Mailing Address - Phone:336-978-4205
Mailing Address - Fax:
Practice Address - Street 1:3719 LATROBE DR STE 850
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4827
Practice Address - Country:US
Practice Address - Phone:336-978-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health