Provider Demographics
NPI:1295199594
Name:MANLEY, CINNAMON (LCSW)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PARKSIDE CENTER BLVD APT 2205
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4364
Mailing Address - Country:US
Mailing Address - Phone:214-912-0471
Mailing Address - Fax:
Practice Address - Street 1:14160 DALLAS PKWY STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4356
Practice Address - Country:US
Practice Address - Phone:972-385-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28593171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator