Provider Demographics
NPI:1558128561
Name:VALENTINE, SHANE (CDCA)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DANE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2415
Mailing Address - Country:US
Mailing Address - Phone:330-313-2901
Mailing Address - Fax:
Practice Address - Street 1:2180 ROMIG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3879
Practice Address - Country:US
Practice Address - Phone:234-334-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)