Provider Demographics
NPI:1124594866
Name:GAMBLE, VALERIE DELORIS (MS, ALC)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:DELORIS
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-0508
Mailing Address - Country:US
Mailing Address - Phone:256-207-6500
Mailing Address - Fax:
Practice Address - Street 1:208 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:AL
Practice Address - Zip Code:36025-1006
Practice Address - Country:US
Practice Address - Phone:334-328-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3170A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000Medicaid