MEDICARE: ABIGAIL SALLIE RAINIE MANNING LPC

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	101YP2500X	Professional Counselor	0701006229	VA

General Provider Information

NPI Number	:	1912382813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL SALLIE RAINIE MANNING LPC

Provider Business Mailing Address
First Line	:	5039 CONNECTICUT AVE NW STE 5
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2056
Country	:	US
Telephone Number	:	703-608-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 CONNECTICUT AVE NW STE 5
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2056
Country	:	US
Telephone Number	:	703-608-8211
Fax Number	:

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

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	01/25/2020

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