Provider Demographics
NPI:1013498237
Name:MANN, CHENEL (COUNSELORINRESIDENCE)
Entity Type:Individual
Prefix:MRS
First Name:CHENEL
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:COUNSELORINRESIDENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19451 PROMENADE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6524
Mailing Address - Country:US
Mailing Address - Phone:703-297-2204
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR STE 250
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8514
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704007620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health