Provider Demographics
NPI:1467475269
Name:MANLEY, TIMOTHY PATRICK (MSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 JUDICIAL DR
Mailing Address - Street 2:FAIRFAX COUNTY ADC , FORENSIC/MENTAL HEALTH SECTION
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5115
Mailing Address - Country:US
Mailing Address - Phone:703-246-4454
Mailing Address - Fax:
Practice Address - Street 1:10520 JUDICIAL DR
Practice Address - Street 2:FAIRFAX COUNTY ADC , FORENSIC/MENTAL HEALTH SECTION
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5115
Practice Address - Country:US
Practice Address - Phone:703-246-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical