Provider Demographics
NPI:1134542665
Name:ALESTOCK, NICOLE MANIGLIA (MED, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MANIGLIA
Last Name:ALESTOCK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1688
Mailing Address - Country:US
Mailing Address - Phone:571-969-1572
Mailing Address - Fax:
Practice Address - Street 1:5280 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1688
Practice Address - Country:US
Practice Address - Phone:571-969-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health