Healthcare Provider Details

I. General information

NPI: 1063525087
Provider Name (Legal Business Name): VALLEY PROFESSIONAL COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAWTHORNE AVE NE
SALEM OR
97301-4675
US

IV. Provider business mailing address

750 HAWTHORNE AVE NE
SALEM OR
97301-4675
US

V. Phone/Fax

Practice location:
  • Phone: 503-370-9200
  • Fax: 503-370-9210
Mailing address:
  • Phone: 503-370-9200
  • Fax: 503-370-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number279
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOR

VIII. Authorized Official

Name: MR. ERIC SAMUEL DAVIS
Title or Position: DIRECTOR
Credential: MSW, CSWA, CADC
Phone: 503-370-9200