Individual
ISAAC GRAY MANIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
245 FOUNTAIN CT STE 225, LEXINGTON, KY 40509-1888
(859) 323-6021
Mailing address
2333 ALUMNI PARK PLZ, SUITE 200, LEXINGTON, KY 40517-4012
(859) 257-7910
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1368
KY
101YA0400X
Addiction (Substance Use Disorder) Counselor
1368
KY
101YM0800X
Mental Health Counselor
1368
KY
1041C0700X
Clinical Social Worker
Primary
1368
KY
Other
Enumeration date
10/24/2006
Last updated
07/13/2020
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