| Doctor Name: | LACONYA MANUEL |
| NPI Number: | 1083964217 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 292 W 4th St Waynesboro, GA - 308301559 |
| Business Phone Number: | 7064376863 |
| Business Fax Number: | 7064376860 |
| Mailing Address: | 223 N Anderson Dr, P O Box 1259 SWAINSBORO |
| State: | GA |
| Postal Code: | 304014440 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2012 |
| NPI Last Update Date: | 09/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |