Provider Demographics
NPI:1467692319
Name:LONG, VALERIE ILENE KVALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ILENE KVALE
Last Name:LONG
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:11495 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6943
Mailing Address - Country:US
Mailing Address - Phone:317-942-4020
Mailing Address - Fax:317-942-4019
Practice Address - Street 1:22811 MACK AVE
Practice Address - Street 2:SUITE L-3
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2021
Practice Address - Country:US
Practice Address - Phone:586-777-0470
Practice Address - Fax:586-777-9879
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2012-08-16
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Provider Licenses
StateLicense IDTaxonomies
MI6301007341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical