Healthcare Provider Details

I. General information

NPI: 1619645678
Provider Name (Legal Business Name): VALOR STATION-AUGUSTA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 TELFAIR ST
AUGUSTA GA
30901-2452
US

IV. Provider business mailing address

404 TELFAIR ST
AUGUSTA GA
30901-2452
US

V. Phone/Fax

Practice location:
  • Phone: 706-670-9797
  • Fax:
Mailing address:
  • Phone: 706-670-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CLIFF RICHARDS
Title or Position: CEO
Credential:
Phone: 706-670-9797