Provider Demographics
NPI:1497227292
Name:DEL VALLE, CARLOS (LMSW)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9093
Mailing Address - Country:US
Mailing Address - Phone:616-885-8202
Mailing Address - Fax:
Practice Address - Street 1:5030 CORPORATE EXCHANGE BLVD SE FL 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-5506
Practice Address - Country:US
Practice Address - Phone:616-885-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011168341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical