Provider Demographics
NPI:1043782196
Name:MANUEL, ASHLIE NICOLE (LPC, RPT)
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:NICOLE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TIMBEROAK CT STE B3
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4567
Mailing Address - Country:US
Mailing Address - Phone:434-381-0902
Mailing Address - Fax:
Practice Address - Street 1:21 TIMBEROAK CT STE B3
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4567
Practice Address - Country:US
Practice Address - Phone:434-381-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional