Provider Demographics
NPI:1093499386
Name:VALELA, GINA M (LLPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:VALELA
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57465 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9799
Mailing Address - Country:US
Mailing Address - Phone:269-273-2024
Mailing Address - Fax:269-273-3191
Practice Address - Street 1:57465 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9799
Practice Address - Country:US
Practice Address - Phone:269-273-2024
Practice Address - Fax:269-273-3191
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health