Provider Demographics
NPI:1356177588
Name:VALENCIA, JOSEPH B (LSAA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 PORTOFINO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3868
Mailing Address - Country:US
Mailing Address - Phone:505-720-6404
Mailing Address - Fax:
Practice Address - Street 1:9421 COORS BLVD NW STE J&K
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5025
Practice Address - Country:US
Practice Address - Phone:505-445-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)