Charles Manda, PHD

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

License

267057 Issued in KY

Practice address

24 Revis Rd
West Liberty, KY 41472-7818

Phone

(502) 436-3533

NPI assigned

May 24, 2021

Last updated

Jun 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1003481805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 REVIS RD",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414727818",
            "telephone_number": "502-436-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 REVIS RD",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414727818",
            "telephone_number": "502-436-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDA",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-24",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "KY",
            "license": "267057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pastoral Counselor in West Liberty, KY
• Providers in West Liberty, KY by specialty
• Pastoral Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.