Provider Demographics
NPI:1356831713
Name:POWELL, VICTORIA IVEY
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IVEY
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 HIGHFIELD DR STE B
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1113
Mailing Address - Country:US
Mailing Address - Phone:412-701-4118
Mailing Address - Fax:610-866-3160
Practice Address - Street 1:3201 HIGHFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1113
Practice Address - Country:US
Practice Address - Phone:412-701-4118
Practice Address - Fax:610-866-3160
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0206021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical