Provider Demographics
NPI:1356509053
Name:PORTANIER, VICTORIA MICHELLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MICHELLE
Last Name:PORTANIER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 QUAILCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:209-416-8832
Mailing Address - Fax:925-370-6504
Practice Address - Street 1:535 MAIN STREET
Practice Address - Street 2:#207
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:209-416-8832
Practice Address - Fax:925-370-6504
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist