Provider Demographics
NPI:1326791468
Name:VALENTICH, GLENDA MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARIA
Last Name:VALENTICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3390
Mailing Address - Country:US
Mailing Address - Phone:352-636-4626
Mailing Address - Fax:
Practice Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6050
Practice Address - Country:US
Practice Address - Phone:817-366-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical