Provider Demographics
NPI:1265939219
Name:VALRIE THERAPY ADVANTAGE, LLC
Entity type:Organization
Organization Name:VALRIE THERAPY ADVANTAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/ OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TEAH
Authorized Official - Middle Name:JONELL
Authorized Official - Last Name:VALRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:843-260-7760
Mailing Address - Street 1:2545 TV RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0701
Mailing Address - Country:US
Mailing Address - Phone:843-260-7760
Mailing Address - Fax:
Practice Address - Street 1:901 W EVANS ST STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3441
Practice Address - Country:US
Practice Address - Phone:843-713-1677
Practice Address - Fax:843-799-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1427430438OtherCAQH