Provider Demographics
NPI:1407335953
Name:VALERA COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:VALERA COUNSELING SERVICES, PLLC
Other - Org Name:VALERA COUNSELING SERVICES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR ASS
Authorized Official - Prefix:
Authorized Official - First Name:MERIDA
Authorized Official - Middle Name:AMARILIS
Authorized Official - Last Name:VALERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:814-218-2598
Mailing Address - Street 1:4680 BROWNSBORO RD RM A2
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3428
Mailing Address - Country:US
Mailing Address - Phone:814-218-2598
Mailing Address - Fax:
Practice Address - Street 1:4680 BROWNSBORO RD RM A2
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3428
Practice Address - Country:US
Practice Address - Phone:814-218-2598
Practice Address - Fax:336-291-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13699101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14202953Medicaid