Healthcare Provider Details

I. General information

NPI: 1316510977
Provider Name (Legal Business Name): VICTOR VALENTOUR PARA-CPSMH/CPSWH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VICTOR VALENTOUR CPSMH/CPSWH

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 07/07/2026
Reactivation Date: 07/31/2026

III. Provider practice location address

375 N BILLUPS ST
ATHENS GA
30606-3070
US

IV. Provider business mailing address

375 N BILLUPS ST
ATHENS GA
30606-3070
US

V. Phone/Fax

Practice location:
  • Phone: 678-598-6252
  • Fax:
Mailing address:
  • Phone: 678-598-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW013070
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: