Provider Demographics
NPI:1447677828
Name:MANCIL, TWYLA LUCINDA (PH D)
Entity type:Individual
Prefix:DR
First Name:TWYLA
Middle Name:LUCINDA
Last Name:MANCIL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1942
Mailing Address - Country:US
Mailing Address - Phone:229-474-9800
Mailing Address - Fax:912-550-4166
Practice Address - Street 1:2236 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1942
Practice Address - Country:US
Practice Address - Phone:229-474-9800
Practice Address - Fax:912-550-4166
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1181103T00000X
GAPSY003935103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003168093DMedicaid
GA003189481AMedicaid