Provider Demographics
NPI:1699400549
Name:VALENTIN, AGNES MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:AGNES
Middle Name:MICHELLE
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WEBB DR STE C
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3921
Mailing Address - Country:US
Mailing Address - Phone:863-438-6806
Mailing Address - Fax:863-582-9396
Practice Address - Street 1:131 WEBB DR STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3921
Practice Address - Country:US
Practice Address - Phone:863-438-6806
Practice Address - Fax:863-582-9396
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health