Provider Demographics
NPI:1053646968
Name:VICTORY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:VICTORY COUNSELING SERVICES, LLC
Other - Org Name:VICTORY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VONETTA
Authorized Official - Middle Name:RESHAN
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-925-8222
Mailing Address - Street 1:185 E MAIN ST
Mailing Address - Street 2:STE 402
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4431
Mailing Address - Country:US
Mailing Address - Phone:269-925-8222
Mailing Address - Fax:269-925-8354
Practice Address - Street 1:185 E MAIN ST
Practice Address - Street 2:STE 402
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4431
Practice Address - Country:US
Practice Address - Phone:269-925-8222
Practice Address - Fax:269-925-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010887381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty