Provider Demographics
NPI:1447661087
Name:MANGUM, ROBBIE (MS,NCC,LPC)
Entity type:Individual
Prefix:MR
First Name:ROBBIE
Middle Name:
Last Name:MANGUM
Suffix:
Gender:M
Credentials:MS,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1541
Mailing Address - Country:US
Mailing Address - Phone:334-201-7477
Mailing Address - Fax:
Practice Address - Street 1:1623 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1541
Practice Address - Country:US
Practice Address - Phone:334-201-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3631101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor