Healthcare Provider Details

I. General information

NPI: 1124583836
Provider Name (Legal Business Name): CRYSTAL VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9311
  • Fax:
Mailing address:
  • Phone: 818-686-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: