Provider Demographics
NPI:1013107408
Name:MANUEL, BONNIE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:A
Last Name:MANUEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:A
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8424 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2319
Mailing Address - Country:US
Mailing Address - Phone:518-522-3628
Mailing Address - Fax:
Practice Address - Street 1:5045 BACKLICK RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6045
Practice Address - Country:US
Practice Address - Phone:571-235-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical