Provider Demographics
NPI:1043102411
Name:MANLEY, ANNA AMELIA (LAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:AMELIA
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1532
Mailing Address - Country:US
Mailing Address - Phone:605-251-4554
Mailing Address - Fax:
Practice Address - Street 1:906 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1532
Practice Address - Country:US
Practice Address - Phone:605-251-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD21031875101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)