Provider Demographics
NPI:1134320211
Name:SUA, VALERIA (CADC-II)
Entity Type:Individual
Prefix:MS
First Name:VALERIA
Middle Name:
Last Name:SUA
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 SHADY LN SPC 41
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-7160
Mailing Address - Country:US
Mailing Address - Phone:619-322-0923
Mailing Address - Fax:
Practice Address - Street 1:6154 MISSION GORGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3493
Practice Address - Country:US
Practice Address - Phone:619-285-1718
Practice Address - Fax:619-285-3803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37ALMedicaid