Provider Demographics
NPI:1023827565
Name:VALENTIN, RAFAEL T JR (LAC (LICENSED COUNSE)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:T
Last Name:VALENTIN
Suffix:JR
Gender:M
Credentials:LAC (LICENSED COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-4024
Mailing Address - Country:US
Mailing Address - Phone:479-599-9617
Mailing Address - Fax:
Practice Address - Street 1:1400 SW SUSANA ST STE 12
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-7877
Practice Address - Country:US
Practice Address - Phone:479-599-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2410016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health