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General NPI Number Information
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NPI Number | 1598318545
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Entity Type | Individual
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Provider Name | BONITA MANNINGS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 14300 GALLANT FOX LN
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 571-343-4366
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 FIELDSTONE CT
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City | HANOVER
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State | MD
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Zip | 21076-2169
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGPC6121
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC12512
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License Number State | MD
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