Provider Demographics
NPI:1578054201
Name:MANLEY, DEMITRIUS DONYELLE (LCSW, LCDC, SAP)
Entity Type:Individual
Prefix:
First Name:DEMITRIUS
Middle Name:DONYELLE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LCSW, LCDC, SAP
Other - Prefix:
Other - First Name:DEMITRIA
Other - Middle Name:DONYELLE
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:3100 WILCREST DR STE 155
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3549
Mailing Address - Country:US
Mailing Address - Phone:346-435-6710
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9450101YA0400X
TX600581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)