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General NPI Number Information
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NPI Number | 1134746167
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Entity Type | Individual
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Provider Name | KETIA LINDA VALCOURT BSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 2431 ALOMA AVE STE 255
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City | WINTER PARK
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State | FL
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Zip | 32792-2541
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Country | US
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Telephone | 407-374-9605
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Fax |
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Provider Business Mailing Address
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Address Line | 10201 WETLAND TRL APT 2018
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City | ORLANDO
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State | FL
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Zip | 32817-5501
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Country | US
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Telephone | 407-374-9605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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