Provider Demographics
NPI: | 1205485034 |
---|---|
Name: | VALLEY'S EDGE INTEGRATIVE COUNSELING |
Entity type: | Organization |
Organization Name: | VALLEY'S EDGE INTEGRATIVE COUNSELING |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RABON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 334-487-3457 |
Mailing Address - Street 1: | 702 N ENGLEWOOD AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DOTHAN |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36303-2582 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 334-487-3457 |
Mailing Address - Fax: | 334-203-9443 |
Practice Address - Street 1: | 702 N ENGLEWOOD AVE |
Practice Address - Street 2: | |
Practice Address - City: | DOTHAN |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36303-2582 |
Practice Address - Country: | US |
Practice Address - Phone: | 334-487-3457 |
Practice Address - Fax: | 334-203-9443 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-09-04 |
Last Update Date: | 2025-05-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |