Provider Demographics
NPI:1366206906
Name:MANOA, ANA T (ADT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:T
Last Name:MANOA
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:OHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4015 28TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3331
Mailing Address - Country:US
Mailing Address - Phone:443-771-7882
Mailing Address - Fax:
Practice Address - Street 1:1048 PAM ANN LN
Practice Address - Street 2:
Practice Address - City:LOTHIAN
Practice Address - State:MD
Practice Address - Zip Code:20711-2600
Practice Address - Country:US
Practice Address - Phone:443-771-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2892101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)