Provider Demographics
NPI:1093431298
Name:DOYLE, VICTORIA GRACE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34208 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4647
Mailing Address - Country:US
Mailing Address - Phone:586-758-6670
Mailing Address - Fax:
Practice Address - Street 1:34208 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4647
Practice Address - Country:US
Practice Address - Phone:586-758-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236Medicaid
MI568946544OtherBCBS
MI5874OtherHEALTH PARTNERS