Provider Demographics
NPI:1700901618
Name:TRAVIS, VALERIE A (LPC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:A
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHURCH RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1412
Mailing Address - Country:US
Mailing Address - Phone:856-904-3525
Mailing Address - Fax:
Practice Address - Street 1:811 CHURCH RD
Practice Address - Street 2:SUITE 137
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1412
Practice Address - Country:US
Practice Address - Phone:856-904-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00318200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2807004000OtherAMERIHEALTH
NJ600024676OtherMAGELLAN