Provider Demographics
NPI:1326194879
Name:MANNER, PAUL I SR (LCPC, NCC, MST)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:I
Last Name:MANNER
Suffix:SR
Gender:M
Credentials:LCPC, NCC, MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8784 OXWELL LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2468
Mailing Address - Country:US
Mailing Address - Phone:301-237-9348
Mailing Address - Fax:301-604-8637
Practice Address - Street 1:8784 OXWELL LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2468
Practice Address - Country:US
Practice Address - Phone:301-237-9348
Practice Address - Fax:301-604-8637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional