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General NPI Number Information
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NPI Number | 1932644671
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Entity Type | Individual
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Provider Name | BRUCE MANISE ED.M, M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 131 PARK ST NE # 8
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City | VIENNA
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State | VA
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Zip | 22180-4641
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Country | US
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Telephone | 703-582-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 CENTRAL AVE
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City | VIENNA
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State | VA
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Zip | 22182-5102
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Country | US
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Telephone | 703-582-0023
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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 | 0701003313
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License Number State | VA
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