Provider Demographics
NPI:1114480340
Name:VALENZUELA, NINFA A (CDPT)
Entity Type:Individual
Prefix:
First Name:NINFA
Middle Name:A
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:NINFA
Other - Middle Name:A
Other - Last Name:ANTONSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:415 N MORAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2667
Mailing Address - Country:US
Mailing Address - Phone:509-735-6900
Mailing Address - Fax:509-735-6914
Practice Address - Street 1:3211 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3810
Practice Address - Country:US
Practice Address - Phone:509-735-6900
Practice Address - Fax:509-735-6914
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60935383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)