Provider Demographics
NPI:1114404357
Name:CAROLYN VALANCIA, FNU (HSD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:CAROLYN VALANCIA
Suffix:
Gender:F
Credentials:HSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 GEORGIA AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3713
Mailing Address - Country:US
Mailing Address - Phone:301-392-7075
Mailing Address - Fax:301-576-5487
Practice Address - Street 1:8701 GEORGIA AVE STE 411
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-392-7075
Practice Address - Fax:301-576-5487
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician