Individual
MR. DAVID GREGORY VALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC, CLA
Contact information
Practice address
3258 NORTH STATE STREET, UKIAH, CA 95482-3052
(707) 234-9472
(707) 463-2045
Mailing address
3258 NORTH STATE STREET, UKIAH, CA 95482-3052
(707) 234-9472
(707) 463-2045
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1135-031613A
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
1135-031613A
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CORPHQ-1135-031613A
CA
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1135-031613A
AOD LICENSE
CA
01
—
45-4980495
IRS TAX ID
—
01
—
DMR0616
NATIONWIDE INSURANC
—
Enumeration date
03/03/2011
Last updated
06/15/2012
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