Provider Demographics
NPI:1528548880
Name:VALENTINE, MARJORIE LUANNE
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:LUANNE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:LUANNE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3811
Mailing Address - Country:US
Mailing Address - Phone:740-351-1188
Mailing Address - Fax:740-351-0567
Practice Address - Street 1:433 3RD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3811
Practice Address - Country:US
Practice Address - Phone:740-354-7545
Practice Address - Fax:740-351-0567
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
C.2002461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator