Provider Demographics
NPI:1841501939
Name:AMIE A. MANIS, PHD, PLLC
Entity type:Organization
Organization Name:AMIE A. MANIS, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:540-958-0670
Mailing Address - Street 1:255 FORGE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-5854
Mailing Address - Country:US
Mailing Address - Phone:540-958-0670
Mailing Address - Fax:540-463-2635
Practice Address - Street 1:120 W NELSON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2036
Practice Address - Country:US
Practice Address - Phone:540-958-0670
Practice Address - Fax:540-463-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004657261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)