Provider Demographics
NPI:1366452294
Name:VARICHAK, VICKY B (LAC)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:B
Last Name:VARICHAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S 1ST ST
Mailing Address - Street 2:SUITE 2 BOX 8
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3532
Mailing Address - Country:US
Mailing Address - Phone:406-375-2454
Mailing Address - Fax:
Practice Address - Street 1:225 S 1ST ST
Practice Address - Street 2:SUITE 2 BOX 8
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3532
Practice Address - Country:US
Practice Address - Phone:406-375-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)