Provider Demographics
| NPI: | 1053646026 |
|---|---|
| Name: | ENGEL, VALERIE JOANNE (CHEMICAL DEPENDENCY) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | VALERIE |
| Middle Name: | JOANNE |
| Last Name: | ENGEL |
| Suffix: | |
| Gender: | F |
| Credentials: | CHEMICAL DEPENDENCY |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 200 S UNION ST APT 2B |
| Mailing Address - Street 2: | |
| Mailing Address - City: | KENNEWICK |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 99336-2275 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 509-491-1072 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 200 S UNION ST APT 2B |
| Practice Address - Street 2: | |
| Practice Address - City: | KENNEWICK |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 99336-2275 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 509-491-1072 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2009-10-08 |
| Last Update Date: | 2018-12-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WA | CP60286094 | 101YA0400X |
| WA | MC60907534 | 101YM0800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WA | 2094197 | Medicaid |