Provider Demographics
NPI:1134608318
Name:STOREY, VALERIE KAY (LMSW,QIDP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:KAY
Last Name:STOREY
Suffix:
Gender:F
Credentials:LMSW,QIDP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:KAY
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW,QIDP
Mailing Address - Street 1:418 W KALAMAZCO AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-553-8062
Mailing Address - Fax:269-553-8104
Practice Address - Street 1:615 E CROSSTOWN PKWY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2501
Practice Address - Country:US
Practice Address - Phone:269-553-7134
Practice Address - Fax:269-373-4951
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010988211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical