Provider Demographics
NPI:1457789059
Name:DELVALLE, EDDIE (LCCC)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:M
Credentials:LCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-4304
Mailing Address - Country:US
Mailing Address - Phone:407-342-4956
Mailing Address - Fax:407-641-8005
Practice Address - Street 1:6021 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4304
Practice Address - Country:US
Practice Address - Phone:407-342-4956
Practice Address - Fax:407-641-8005
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCCC-076698101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor