Provider Demographics
NPI:1275061772
Name:MANLEY, MONIQUE (NCMA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W 26TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2356
Mailing Address - Country:US
Mailing Address - Phone:907-854-8969
Mailing Address - Fax:
Practice Address - Street 1:1331 W 26TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2356
Practice Address - Country:US
Practice Address - Phone:907-854-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1017106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician