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General NPI Number Information
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NPI Number | 1841501939
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Entity Type | Organization
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Legal Business Name | AMIE A. MANIS, PHD, PLLC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 120 W NELSON ST
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City | LEXINGTON
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State | VA
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Zip | 24450-2036
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Country | US
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Telephone | 540-958-0670
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Fax | 540-463-2635
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Provider Business Mailing Address
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Address Line | 255 FORGE RD
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City | LEXINGTON
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State | VA
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Zip | 24450-5854
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Country | US
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Telephone | 540-958-0670
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Fax | 540-463-2635
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AMIE A. MANIS
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Credential | PHD, LPC
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Telephone | 540-958-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0701004657
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License Number State | VA
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