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General NPI Number Information
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NPI Number | 1578054201
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Entity Type | Individual
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Provider Name | DEMITRIUS DONYELLE MANLEY LCSW, LCDC, SAP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 6315 GULFTON ST STE 100
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City | HOUSTON
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State | TX
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Zip | 77081-1107
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Country | US
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Telephone | 713-457-4372
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Fax | 713-457-0945
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Provider Business Mailing Address
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Address Line | 3100 WILCREST DR STE 155
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City | HOUSTON
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State | TX
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Zip | 77042-3549
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Country | US
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Telephone | 346-435-6710
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9450
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 60058
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License Number State | TX
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