Provider Demographics
NPI:1134746167
Name:VALCOURT, KETIA LINDA (BSW)
Entity type:Individual
Prefix:
First Name:KETIA
Middle Name:LINDA
Last Name:VALCOURT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 WETLAND TRL APT 2018
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-5501
Mailing Address - Country:US
Mailing Address - Phone:407-374-9605
Mailing Address - Fax:
Practice Address - Street 1:2431 ALOMA AVE STE 255
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-374-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management