Provider Demographics
NPI:1346370962
Name:MANNING, LISA DAWN GREEN (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN GREEN
Last Name:MANNING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HIRST RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6199
Mailing Address - Country:US
Mailing Address - Phone:703-470-5952
Mailing Address - Fax:
Practice Address - Street 1:205 HIRST RD STE 103
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6199
Practice Address - Country:US
Practice Address - Phone:703-470-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical