MEDICARE: MR. MICHAEL MCMANUS LPC, LSATP, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0718000280	VA
2	101YM0800X	Mental Health Counselor	MH 7577	FL
3	101YP2500X	Professional Counselor	0701006676	VA

General Provider Information

NPI Number	:	1144531302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL MCMANUS LPC, LSATP, LMHC

Provider Business Mailing Address
First Line	:	6603 IRONGATE SQ
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6081
Country	:	US
Telephone Number	:	804-743-0960
Fax Number	:	804-743-1175

Provider Business Practice Location Address
First Line	:	6603 IRONGATE SQ
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6081
Country	:	US
Telephone Number	:	804-743-0960
Fax Number	:	804-743-1175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	03/17/2018

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