Provider Demographics
NPI:1346968740
Name:MANLEY, ROYIA
Entity Type:Individual
Prefix:
First Name:ROYIA
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SALTWELL RD
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-7003
Mailing Address - Country:US
Mailing Address - Phone:859-274-7250
Mailing Address - Fax:
Practice Address - Street 1:701 UPSHAW LN
Practice Address - Street 2:
Practice Address - City:KEVIL
Practice Address - State:KY
Practice Address - Zip Code:42053-7901
Practice Address - Country:US
Practice Address - Phone:270-443-4743
Practice Address - Fax:270-443-4717
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278155101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY278155OtherKENTUCKY STATE LICENSE