Provider Demographics
NPI:1154029205
Name:MANLEY, MAURICE
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:MANLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 CROSSWAYS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0218
Mailing Address - Country:US
Mailing Address - Phone:757-378-6925
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:1545 CROSSWAYS BLVD, SUITE 250
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VIRGINIA
Practice Address - Zip Code:23320
Practice Address - Country:UM
Practice Address - Phone:757-378-6925
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician