Provider Demographics
NPI:1184828642
Name:CHADWICK, VICTORIA COLE (MDIVMA,LPC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:COLE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MDIVMA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16527 GREEN DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7680
Mailing Address - Country:US
Mailing Address - Phone:704-892-1566
Mailing Address - Fax:
Practice Address - Street 1:5203 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4721
Practice Address - Country:US
Practice Address - Phone:704-554-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional