Provider Demographics
NPI:1386831477
Name:VALLEY CENTER COUNSELING, INC.
Entity Type:Organization
Organization Name:VALLEY CENTER COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL WORKER, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BLAZEJ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:760-685-3403
Mailing Address - Street 1:127 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4254
Mailing Address - Country:US
Mailing Address - Phone:760-685-3403
Mailing Address - Fax:760-751-8650
Practice Address - Street 1:127 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4254
Practice Address - Country:US
Practice Address - Phone:760-685-3403
Practice Address - Fax:760-751-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASW21570251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19512Medicare UPIN
CASW21570AMedicare PIN