Provider Demographics
NPI:1679622476
Name:DE LENA, VALORIE LYNN (MA, MFT)
Entity type:Individual
Prefix:
First Name:VALORIE
Middle Name:LYNN
Last Name:DE LENA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:VALORIE
Other - Middle Name:LYNN
Other - Last Name:MICKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3468 MT DIABLO BLVD
Mailing Address - Street 2:SUITE B-201
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3957
Mailing Address - Country:US
Mailing Address - Phone:925-295-0342
Mailing Address - Fax:925-284-1599
Practice Address - Street 1:3468 MT DIABLO BLVD
Practice Address - Street 2:SUITE B-301
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3957
Practice Address - Country:US
Practice Address - Phone:925-295-0342
Practice Address - Fax:925-284-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19-246-0OtherCC CO. DEPT HUMAN SVCS.
CA09036OtherMEDI-CAL PROVIDER NUMBER