Provider Demographics
NPI:1336793371
Name:VALENCIA, JACQUELINE STEPHANIE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:STEPHANIE
Last Name:VALENCIA
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 1:116 ROMERO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4634
Mailing Address - Country:US
Mailing Address - Phone:323-712-9358
Mailing Address - Fax:
Practice Address - Street 1:5659 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2811
Practice Address - Country:US
Practice Address - Phone:702-846-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)