Provider Demographics
NPI:1942683206
Name:MANLEY, CONSTANCE LAVERNE (LPC, BSL)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LAVERNE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LPC, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 MOUNT CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-3102
Mailing Address - Country:US
Mailing Address - Phone:814-341-6679
Mailing Address - Fax:
Practice Address - Street 1:1765 GOUCHER ST STE 150
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1101
Practice Address - Country:US
Practice Address - Phone:814-535-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014154101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional