Provider Demographics
NPI:1205855350
Name:NAERT, VICTORIA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MARIE
Last Name:NAERT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:BOUCKAERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1513 COLUMBUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-391-4212
Mailing Address - Fax:989-391-4214
Practice Address - Street 1:1513 COLUMBUS AVENUE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-391-4212
Practice Address - Fax:989-391-4214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009063101YP2500X
MI68020821111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013790OtherHEALTH PLUS