Provider Demographics
NPI:1891210514
Name:MACK, VALERIE (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MACK
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:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9104
Mailing Address - Country:US
Mailing Address - Phone:804-514-2385
Mailing Address - Fax:
Practice Address - Street 1:12801 IRON BRIDGE RD STE 400
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-768-0295
Practice Address - Fax:804-768-8001
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical