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General NPI Number Information
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NPI Number | 1437461852
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Entity Type | Individual
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Provider Name | GEORGENE ANN MANLEY LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 701 LEE ST
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City | DES PLAINES
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State | IL
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Zip | 60016-4539
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Country | US
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Telephone | 847-795-3962
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Fax |
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Provider Business Mailing Address
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Address Line | 2639 PROVIDENCE LN
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City | LINDENHURST
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State | IL
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Zip | 60046-4947
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Country | US
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Telephone | 847-265-6044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-005662
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License Number State | IL
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