Provider Demographics
NPI:1285236588
Name:BROCK, VALERIE L (LCSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:BROCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S. SEWARD MERIDIAN PKWY A,B, C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5327
Mailing Address - Country:US
Mailing Address - Phone:907-631-3520
Mailing Address - Fax:
Practice Address - Street 1:4006 S TRELLIS AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8572
Practice Address - Country:US
Practice Address - Phone:907-223-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X, 101YM0800X
AK1942821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health