Provider Demographics
NPI:1023698784
Name:GAULT, VALERIA
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:GAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 PEYTON WOODS TRL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2156
Mailing Address - Country:US
Mailing Address - Phone:404-326-4473
Mailing Address - Fax:
Practice Address - Street 1:2587 PEYTON WOODS TRL SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2156
Practice Address - Country:US
Practice Address - Phone:404-326-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2022-11-01
Deactivation Date:2022-10-18
Deactivation Code:
Reactivation Date:2022-11-01
Provider Licenses
StateLicense IDTaxonomies
GACSW74731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty