Healthcare Provider Details

I. General information

NPI: 1023114907
Provider Name (Legal Business Name): COLLEEN MANION LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W BROAD ST STE A
RICHMOND VA
23230-1714
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-237-3000
  • Fax: 804-673-2731
Mailing address:
  • Phone: 804-391-4171
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: