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1679103691
LEECHANN MCMANUS
STATESVILLE, NC
NPI
1679103691
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Other Name
KEDIAN DARIUS TABORN
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2020-01-17
Last Update Date
2020-01-17
Business Address
Mr. LEECHANN MCMANUS Executive Director
440 CHARLES ST
STATESVILLE, NC 28677-6806
Phone number: 704-257-1086
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Mailing Address
Mr. LEECHANN MCMANUS Executive Director
440 CHARLES ST
STATESVILLE, NC 28677-6806
Phone number: 704-257-1086
Copy
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