Provider Demographics
NPI:1669640090
Name:VALLETTA, ANDREA J (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:VALLETTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SALEM WOODS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3343
Mailing Address - Country:US
Mailing Address - Phone:919-609-2564
Mailing Address - Fax:919-930-8712
Practice Address - Street 1:804 SALEM WOODS DR STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3343
Practice Address - Country:US
Practice Address - Phone:919-609-2564
Practice Address - Fax:919-930-8712
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical