Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LGP114 | MD |
NPI | 1053305904 |
---|---|
Provider Name | Mrs. Diane Donley Mankus |
First Address | Frederick, MD 21703-8381 |
Second Address | Parkville, MD 21234-5888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |