Provider Demographics
NPI:1114368453
Name:VICTORY PROGRAMS WOMEN'S HOPE
Entity Type:Organization
Organization Name:VICTORY PROGRAMS WOMEN'S HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE USE DISORDER COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:617-442-0048
Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:11 SOUTH
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:11 SOUTH
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-442-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218529324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility