Provider Demographics
NPI:1205195807
Name:VICTORIA C. YOUNGBLOOD
Entity Type:Organization
Organization Name:VICTORIA C. YOUNGBLOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CAC III, LPC
Authorized Official - Phone:719-459-6710
Mailing Address - Street 1:2019 E BIJOU ST
Mailing Address - Street 2:SUITE NUMBER 2
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5818
Mailing Address - Country:US
Mailing Address - Phone:719-459-6710
Mailing Address - Fax:719-465-3150
Practice Address - Street 1:2019 E BIJOU ST
Practice Address - Street 2:SUITE NUMBER 2
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5818
Practice Address - Country:US
Practice Address - Phone:719-459-6710
Practice Address - Fax:719-465-3150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AYUDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4082101YA0400X
CO1575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty