Doctor Name: | NICOLE MANIGLIA ALESTOCK |
NPI Number: | 1134542665 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED, LPC |
License Number: | 0701005212 |
Business Practice Address: | 5280 Lyngate Ct Burke, VA - 220151688 |
Business Phone Number: | 5719691572 |
Business Fax Number: | |
Mailing Address: | 5280 Lyngate Ct, BURKE |
State: | VA |
Postal Code: | 220151688 |
Phone Number: | 5719691572 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2014 |
NPI Last Update Date: | 03/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0701005212 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |