Provider Demographics
NPI:1285911420
Name:VALENTINE, NICOLE N
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:N
Last Name:VALENTINE
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 1:19 SPRING FALLS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-7101
Mailing Address - Country:US
Mailing Address - Phone:803-414-2428
Mailing Address - Fax:864-999-2090
Practice Address - Street 1:104 COMMONS BLVD STE B
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7766
Practice Address - Country:US
Practice Address - Phone:864-513-3334
Practice Address - Fax:864-999-2090
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBA1087Medicaid