Healthcare Provider Details

I. General information

NPI: 1710421094
Provider Name (Legal Business Name): VALERIE VALENTINE STUDIOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR SUITE 701-A
SANTA FE NM
87505-5459
US

IV. Provider business mailing address

1925 ASPEN DR SUITE 701-A
SANTA FE NM
87505-5459
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-2469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC0157181
License Number StateNM

VIII. Authorized Official

Name: VALERIE VALENTINE
Title or Position: OWNER
Credential: PC
Phone: 505-577-2469