MEDICARE: NICHOLAS M VALDES MA, CAADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C0323	GA
2	101YM0800X	Mental Health Counselor	LPC015362	GA

General Provider Information

NPI Number	:	1053904276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS M VALDES MA, CAADC

Provider Business Mailing Address
First Line	:	380 DAHLONEGA ST STE 100
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8219
Country	:	US
Telephone Number	:	678-771-8468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 WHISPERING CIR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-4504
Country	:	US
Telephone Number	:	404-579-8687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	10/29/2025

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