Provider Demographics
NPI:1053465484
Name:BAUSCH, VICTORIA MILLER (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MILLER
Last Name:BAUSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3281
Mailing Address - Country:US
Mailing Address - Phone:478-290-8662
Mailing Address - Fax:
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD BLDG 16100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4100
Practice Address - Country:US
Practice Address - Phone:770-939-1288
Practice Address - Fax:770-212-2203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical