Provider Demographics
NPI:1528405404
Name:VALENTINE, GRACE EVELYN (MA, BC-DMT, DTRL)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EVELYN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MA, BC-DMT, DTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2802
Mailing Address - Country:US
Mailing Address - Phone:608-251-0908
Mailing Address - Fax:608-251-0939
Practice Address - Street 1:16 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2802
Practice Address - Country:US
Practice Address - Phone:608-251-0908
Practice Address - Fax:608-251-0939
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5-037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health