Provider Demographics
NPI:1003839259
Name:VALENTINE, SUSAN M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 QUEEN ANNE AVE N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4518
Mailing Address - Country:US
Mailing Address - Phone:206-550-5346
Mailing Address - Fax:425-454-3993
Practice Address - Street 1:419 QUEEN ANNE AVE N
Practice Address - Street 2:SUITE 108
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4518
Practice Address - Country:US
Practice Address - Phone:206-550-5346
Practice Address - Fax:425-454-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB00029723101YA0400X
WA020704-LW-0000-73281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical