Provider Demographics
NPI:1831923366
Name:MANNING, NICOLE LYNN (AMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:MANNING
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2316
Mailing Address - Country:US
Mailing Address - Phone:415-699-2159
Mailing Address - Fax:
Practice Address - Street 1:1607 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2316
Practice Address - Country:US
Practice Address - Phone:415-699-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist