Provider Demographics
NPI:1073278040
Name:MANNION, BETHANY (LCMHC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MANNION
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8028
Mailing Address - Country:US
Mailing Address - Phone:336-383-1665
Mailing Address - Fax:
Practice Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8028
Practice Address - Country:US
Practice Address - Phone:336-383-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty