Provider Demographics
NPI:1871604710
Name:MANNEL, JANET (LISW-CP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MANNEL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MEDICAL CIR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3612
Mailing Address - Country:US
Mailing Address - Phone:803-796-6851
Mailing Address - Fax:
Practice Address - Street 1:160 MEDICAL CIR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3612
Practice Address - Country:US
Practice Address - Phone:803-796-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
84161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ33945Medicare UPIN