Provider Demographics
NPI:1316576598
Name:VICTORIA COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:VICTORIA COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, AMFT
Authorized Official - Phone:559-978-1012
Mailing Address - Street 1:PO BOX 78152
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30357-2152
Mailing Address - Country:US
Mailing Address - Phone:559-978-1012
Mailing Address - Fax:
Practice Address - Street 1:3059 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7809
Practice Address - Country:US
Practice Address - Phone:770-609-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty