Provider Demographics
NPI:1285829044
Name:KETTERING, VICTORIA M (LPCC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:KETTERING
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 S COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9215
Mailing Address - Country:US
Mailing Address - Phone:937-667-4678
Mailing Address - Fax:937-667-4963
Practice Address - Street 1:7695 S COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-9215
Practice Address - Country:US
Practice Address - Phone:937-667-4678
Practice Address - Fax:937-667-4963
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health