Provider Demographics
NPI:1891411351
Name:VALOR BEHAVIORAL HELATH, LLC
Entity Type:Organization
Organization Name:VALOR BEHAVIORAL HELATH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-353-7632
Mailing Address - Street 1:7620 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1190 W DRUID HILLS DR NE STE 150
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2121
Practice Address - Country:US
Practice Address - Phone:323-353-7632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health