Provider Demographics
NPI:1033484449
Name:LISTON, VICTORIA ANN (BSW, CADC)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ANN
Last Name:LISTON
Suffix:
Gender:F
Credentials:BSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 VADALABENE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5632
Mailing Address - Country:US
Mailing Address - Phone:618-288-3100
Mailing Address - Fax:618-288-3371
Practice Address - Street 1:2148 VADALABENE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5632
Practice Address - Country:US
Practice Address - Phone:618-288-3100
Practice Address - Fax:618-288-3371
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150.013697104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical