Provider Demographics
NPI:1215473897
Name:VALLOR, JESSICA ERIN (MS ART THERAPY)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN
Last Name:VALLOR
Suffix:
Gender:F
Credentials:MS ART THERAPY
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ERIN
Other - Last Name:STALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 SUMMER TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2663
Mailing Address - Country:US
Mailing Address - Phone:941-321-5874
Mailing Address - Fax:
Practice Address - Street 1:255 VILLAGE PKWY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4158
Practice Address - Country:US
Practice Address - Phone:770-726-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2019-03-30
Deactivation Date:2019-03-07
Deactivation Code:
Reactivation Date:2019-03-29
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAAPC006481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health