Provider Demographics
NPI:1336812098
Name:VALICENTI, JAMES MARQUI (LLMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARQUI
Last Name:VALICENTI
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:501 N MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2827
Mailing Address - Country:US
Mailing Address - Phone:800-395-3223
Mailing Address - Fax:833-329-6632
Practice Address - Street 1:26184 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2084
Practice Address - Country:US
Practice Address - Phone:313-389-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110607104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker