MEDICARE: MRS. KIMBERLY D MANLEY MA

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	101Y00000X	Counselor	A7659	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A7659	OTHER	NC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1295169357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY D MANLEY MA

Provider Business Mailing Address
First Line	:	304 W FISHER AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2044
Country	:	US
Telephone Number	:	336-207-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 W FISHER AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2044
Country	:	US
Telephone Number	:	336-207-8603
Fax Number	:

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

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	08/26/2013

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