Provider Demographics
NPI:1114792538
Name:POWELL, VICTORIA GRACE (MA, R-DMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 BOURBON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-416-2850
Mailing Address - Fax:
Practice Address - Street 1:2431 PRINCE ANDREW CT
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1388
Practice Address - Country:US
Practice Address - Phone:804-335-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor