Provider Demographics
NPI:1235416439
Name:PELTON, VICTORIA (MA, LLP, CAADC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:PELTON
Suffix:
Gender:F
Credentials:MA, LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7199 KALAMAZOO AVE SE STE 232
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7362
Mailing Address - Country:US
Mailing Address - Phone:616-803-9422
Mailing Address - Fax:616-277-7141
Practice Address - Street 1:7199 KALAMAZOO AVE SE STE 232
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7362
Practice Address - Country:US
Practice Address - Phone:616-803-9422
Practice Address - Fax:616-277-7141
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical