Provider Demographics
NPI:1730106790
Name:KVALHEIM, LORENA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:L
Last Name:KVALHEIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 341648
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-254-9210
Mailing Address - Fax:937-254-9267
Practice Address - Street 1:1020 WOODMAN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432
Practice Address - Country:US
Practice Address - Phone:937-254-9210
Practice Address - Fax:937-254-9267
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical