Provider Demographics
NPI:1982387478
Name:VALENTINE, TODD PRENTICE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:PRENTICE
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CLEARVIEW PL
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2116
Mailing Address - Country:US
Mailing Address - Phone:678-805-5158
Mailing Address - Fax:770-216-9609
Practice Address - Street 1:2801 CLEARVIEW PL
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2116
Practice Address - Country:US
Practice Address - Phone:678-805-5158
Practice Address - Fax:770-216-9609
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004833101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor