Provider Demographics
NPI:1013394733
Name:HARRIOTT, VALENCIA
Entity type:Individual
Prefix:
First Name:VALENCIA
Middle Name:
Last Name:HARRIOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MIDDLEHURST RD APT 202
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1651
Mailing Address - Country:US
Mailing Address - Phone:973-820-1915
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1218
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4003
Practice Address - Country:US
Practice Address - Phone:213-712-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty