Provider Demographics
NPI:1407917255
Name:WEST, VICTORIA LANGFAHL (LCPC CADC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LANGFAHL
Last Name:WEST
Suffix:
Gender:F
Credentials:LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 N SHERIDAN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2922
Mailing Address - Country:US
Mailing Address - Phone:309-589-0909
Mailing Address - Fax:
Practice Address - Street 1:6401 N SHERIDAN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2922
Practice Address - Country:US
Practice Address - Phone:309-589-0909
Practice Address - Fax:309-589-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22162101YA0400X
IL180001014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)