Provider Demographics
NPI:1205043106
Name:PHILIPPE, VICTORIA LYNNE (CADC-II NCAC-I ICADC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNNE
Last Name:PHILIPPE
Suffix:
Gender:F
Credentials:CADC-II NCAC-I ICADC
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:LYNNE
Other - Last Name:PHILIPPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC-II NCAC-I ICADC
Mailing Address - Street 1:1731 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6232
Mailing Address - Country:US
Mailing Address - Phone:559-732-4885
Mailing Address - Fax:559-732-8289
Practice Address - Street 1:1425 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1415
Practice Address - Country:US
Practice Address - Phone:559-625-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-031116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043346067Medicare UPIN