Provider Demographics
NPI:1942841952
Name:VALENTINE, STANLEY JEROME (CADC)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JEROME
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5474
Mailing Address - Country:US
Mailing Address - Phone:815-730-7521
Mailing Address - Fax:
Practice Address - Street 1:2400 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5474
Practice Address - Country:US
Practice Address - Phone:815-730-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)