Provider Demographics
NPI:1699038612
Name:MANLEY, HOLLY ANN (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SADDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8772
Mailing Address - Country:US
Mailing Address - Phone:919-221-4116
Mailing Address - Fax:
Practice Address - Street 1:201 STEVENS MILL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist