Provider Demographics
NPI:1972797629
Name:MANLEY, KRISTI ANNETTE (LMHC LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANNETTE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LMHC LCPC
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:ANNETTE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CADC I
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-2031
Mailing Address - Fax:309-779-2167
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5351
Practice Address - Country:US
Practice Address - Phone:309-779-2031
Practice Address - Fax:309-779-2167
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001087OtherLICENSED MENTAL HEALTH COUNSELOR
IL180.007471OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR