Provider Demographics
NPI:1023015161
Name:VALENCIA, TERRIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 HIGHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8105
Mailing Address - Country:US
Mailing Address - Phone:859-582-2666
Mailing Address - Fax:
Practice Address - Street 1:1043 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1090
Practice Address - Country:US
Practice Address - Phone:502-262-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82000324Medicaid
KY0676420Medicare ID - Type Unspecified