Healthcare Provider Details

I. General information

NPI: 1528548880
Provider Name (Legal Business Name): MARJORIE LUANNE VALENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE LUANNE NICHOLS

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 3RD ST
PORTSMOUTH OH
45662-3811
US

IV. Provider business mailing address

433 3RD ST
PORTSMOUTH OH
45662-3811
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-7545
  • Fax: 740-351-0567
Mailing address:
  • Phone: 740-351-1188
  • Fax: 740-351-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2002461
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: