Provider Demographics
NPI:1447642293
Name:BAHAM, VALERIE
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:BAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 CHEROKEE VILLA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2008
Mailing Address - Country:US
Mailing Address - Phone:904-699-4370
Mailing Address - Fax:
Practice Address - Street 1:3755 CHEROKEE VILLA LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2008
Practice Address - Country:US
Practice Address - Phone:904-699-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor