Provider Demographics
NPI:1356742860
Name:VALENTINE, KESHA RENEE (LSW)
Entity type:Individual
Prefix:
First Name:KESHA
Middle Name:RENEE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KESHA
Other - Middle Name:R
Other - Last Name:MACHATERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4510 DORR ST # MS 840
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:419-383-6843
Mailing Address - Fax:419-383-3338
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-6843
Practice Address - Fax:419-383-3338
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0900827104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker