Provider Demographics
NPI:1902318587
Name:VALENTINE, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FAIRFOREST WAY APT 17208
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4677
Mailing Address - Country:US
Mailing Address - Phone:864-386-7604
Mailing Address - Fax:
Practice Address - Street 1:221 FAIRFOREST WAY APT 17208
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4677
Practice Address - Country:US
Practice Address - Phone:864-386-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8950933172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver