Provider Demographics
NPI:1972098416
Name:VALENZUELA, RACHELLE RAQUEL (CADCIII)
Entity type:Individual
Prefix:MISS
First Name:RACHELLE
Middle Name:RAQUEL
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2015
Mailing Address - Country:US
Mailing Address - Phone:510-804-6485
Mailing Address - Fax:
Practice Address - Street 1:256 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-2015
Practice Address - Country:US
Practice Address - Phone:510-804-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1313290618101YA0400X
CACI30320720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty