Provider Demographics
NPI:1043508658
Name:JORDAN SPICER, VICTORIA ROSETTA (LPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSETTA
Last Name:JORDAN SPICER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 PLEASANT FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3217
Mailing Address - Country:US
Mailing Address - Phone:210-602-8793
Mailing Address - Fax:
Practice Address - Street 1:9897 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1826
Practice Address - Country:US
Practice Address - Phone:210-602-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional