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General NPI Number Information
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NPI Number | 1881367480
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Entity Type | Individual
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Provider Name | ANNETTE ANTHONIA MANZANO LPC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 15 HOPE RD
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City | STAFFORD
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State | VA
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Zip | 22554-7202
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Country | US
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Telephone | 540-659-2725
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Fax |
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Provider Business Mailing Address
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Address Line | 11413 MACPHERSON CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-2062
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Country | US
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Telephone | 540-642-0060
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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 | 0701010652
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License Number State | VA
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