Healthcare Provider Details

I. General information

NPI: 1316967243
Provider Name (Legal Business Name): VALERIE A. KACK LCSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE A. KACK-BRICE LCSW

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 SMITH RD
GRASS VALLEY CA
95949-7506
US

IV. Provider business mailing address

10350 SMITH RD
GRASS VALLEY CA
95949-7506
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-7632
  • Fax: 530-272-7632
Mailing address:
  • Phone: 530-272-7632
  • Fax: 530-272-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12327
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: