Basic Information
| Provider Information | |||||||||
| NPI: | 1912174822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VON DRAN | ||||||||
| FirstName: | VALENCIA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 TURNERSBURG HWY | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286252798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048731114 | ||||||||
| FaxNumber: | 7048738626 | ||||||||
| Practice Location | |||||||||
| Address1: | 318 TURNERSBURG HWY | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286252798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048731114 | ||||||||
| FaxNumber: | 7048738626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2008 | ||||||||
| LastUpdateDate: | 02/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7051 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 2005 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 6103994 | 05 | NC | MEDICAID |