Provider Demographics
NPI:1295854750
Name:VALENTINE AND ASSOCIATES PA
Entity Type:Organization
Organization Name:VALENTINE AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-779-3188
Mailing Address - Street 1:1201 AVERSBORO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5208
Mailing Address - Country:US
Mailing Address - Phone:919-779-3188
Mailing Address - Fax:919-779-4223
Practice Address - Street 1:1201 AVERSBORO RD
Practice Address - Street 2:SUITE C
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-5208
Practice Address - Country:US
Practice Address - Phone:919-779-3188
Practice Address - Fax:919-779-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1118103T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS11691Medicare UPIN
NC2815725Medicare ID - Type Unspecified