Charles Manda, PHD
Individual provider Active NPI Pastoral Counselor · West Liberty, KY
NPI 1003481805 · NPPES record last updated Jun 5, 2023
Key facts
- NPI
- 1003481805
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pastoral Counselor 101YP1600X
- License
- 267057 (KY)
- Practice address
- 24 Revis Rd
West Liberty, KY 41472-7818 - Phone
- (502) 436-3533
- NPI assigned
- May 24, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 267057 | KY | MD | Pastoral Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 267057 | KY | Yes |
Addresses
Primary practice location
24 Revis Rd
West Liberty, KY 41472-7818
Mailing address
24 Revis Rd
West Liberty, KY 41472-7818
Phone (502) 436-3533
Other providers in West Liberty, KY
- Jonathan Ray Lawson
- Abby Lewis
- Nancy Lewis
- Nathan Lewis
- Dandan Li
- Andrea Mason
- Lesa Keaton Mattingly
- Sandra K McClure
- Brittany McCraw
- Lee Ann McKenzie
All providers in West Liberty, KY · Pastoral Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.