Provider Demographics
NPI:1144389156
Name:BALENGER, VICTORIA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:J
Last Name:BALENGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1736
Mailing Address - Country:US
Mailing Address - Phone:301-897-0871
Mailing Address - Fax:301-415-1226
Practice Address - Street 1:1485 CHAIN BRIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4511
Practice Address - Country:US
Practice Address - Phone:703-909-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810-002414103TC1900X
MD657732103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491177Medicare ID - Type UnspecifiedMEDICARE ID