Provider Demographics
NPI:1902027725
Name:VALENCIA, MARIA (MED, CDPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MED, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 NASS RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:WA
Mailing Address - Zip Code:98932-9764
Mailing Address - Country:US
Mailing Address - Phone:509-594-7824
Mailing Address - Fax:
Practice Address - Street 1:1353 NASS RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932-9764
Practice Address - Country:US
Practice Address - Phone:509-594-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60163683101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health