Provider Demographics
NPI:1063046852
Name:VALLADARES CARCAMO, JACKELIN
Entity type:Individual
Prefix:
First Name:JACKELIN
Middle Name:
Last Name:VALLADARES CARCAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26315 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1962
Mailing Address - Country:US
Mailing Address - Phone:281-651-5120
Mailing Address - Fax:
Practice Address - Street 1:350 N SAM HOUSTON PKWY E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3315
Practice Address - Country:US
Practice Address - Phone:832-761-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health