Individual
MR. BRUCE MANISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.M, M.A.
Contact information
Practice address
131 PARK ST NE # 8, VIENNA, VA 22180-4641
(703) 582-0023
Mailing address
2203 CENTRAL AVE, VIENNA, VA 22182-5102
(703) 582-0023
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003313
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701003313
LICENSED PROFESSIONAL COUNSELOR
VA
Enumeration date
01/05/2017
Last updated
01/05/2017
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