Provider Demographics
NPI:1225502180
Name:VALENTIN, GRACE M
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 S ORANGE BLOSSOM TRL STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5734
Mailing Address - Country:US
Mailing Address - Phone:402-570-4597
Mailing Address - Fax:
Practice Address - Street 1:6900 S ORANGE BLOSSOM TRL STE 402
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5734
Practice Address - Country:US
Practice Address - Phone:402-570-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health