Provider Demographics
NPI:1669770426
Name:VALLEY, DAVID GREGORY (CSAC, CLA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GREGORY
Last Name:VALLEY
Suffix:
Gender:M
Credentials:CSAC, CLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3052
Mailing Address - Country:US
Mailing Address - Phone:707-234-9472
Mailing Address - Fax:707-463-2045
Practice Address - Street 1:3258 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3052
Practice Address - Country:US
Practice Address - Phone:707-234-9472
Practice Address - Fax:707-463-2045
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACORPHQ-1135-031613A101YA0400X
320800000X
CA1135-031613A101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
DMR0616OtherNATIONWIDE INSURANC
CA1135-031613AOtherAOD LICENSE
45-4980495OtherIRS TAX ID