Provider Demographics
NPI:1295169357
Name:MANLEY, KIMBERLY D (MA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2044
Mailing Address - Country:US
Mailing Address - Phone:336-207-8603
Mailing Address - Fax:
Practice Address - Street 1:304 W FISHER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2044
Practice Address - Country:US
Practice Address - Phone:336-207-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7659101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA7659OtherSTATE LICENSE NUMBER