Provider Demographics
NPI:1275348906
Name:VALENTINE, MICHAEL (BEHAVIORAL TECHNICIA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:BEHAVIORAL TECHNICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 VARDAMAN ST APT 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3876
Mailing Address - Country:US
Mailing Address - Phone:980-505-3629
Mailing Address - Fax:
Practice Address - Street 1:709 VARDAMAN ST APT 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3876
Practice Address - Country:US
Practice Address - Phone:980-505-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator