Provider Demographics
NPI:1154070225
Name:VICTORS IN EDEN LLC
Entity Type:Organization
Organization Name:VICTORS IN EDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:470-829-1333
Mailing Address - Street 1:4854 OLD NATIONAL HWY STE 167
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6201
Mailing Address - Country:US
Mailing Address - Phone:470-829-1333
Mailing Address - Fax:404-500-5983
Practice Address - Street 1:2 SABLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854
Practice Address - Country:US
Practice Address - Phone:470-829-1333
Practice Address - Fax:404-500-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health