MEDICARE: STACEY ARLEEN MANLEY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1881272706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ARLEEN MANLEY

Provider Business Mailing Address
First Line	:	818 SEMINOLE DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4131
Country	:	US
Telephone Number	:	757-334-0773
Fax Number	:	757-809-5797

Provider Business Practice Location Address
First Line	:	818 SEMINOLE DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4131
Country	:	US
Telephone Number	:	757-334-0773
Fax Number	:	757-809-5797

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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Directions to “ STACEY ARLEEN MANLEY ” Practice Location

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