Provider Demographics
NPI:1265778955
Name:MANNING, JOHNNY LEROY
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:LEROY
Last Name:MANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9408 NIGHT HARBOR DR SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9594
Mailing Address - Country:US
Mailing Address - Phone:910-833-4113
Mailing Address - Fax:
Practice Address - Street 1:9408 NIGHT HARBOR DR SE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9594
Practice Address - Country:US
Practice Address - Phone:910-833-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)