Provider Demographics
NPI:1417357120
Name:MEXCUR, VICTORIA (MS ED, LIMHP, LADC,)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MEXCUR
Suffix:
Gender:F
Credentials:MS ED, LIMHP, LADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:IRON STATION
Mailing Address - State:NC
Mailing Address - Zip Code:28080-9214
Mailing Address - Country:US
Mailing Address - Phone:402-403-9561
Mailing Address - Fax:
Practice Address - Street 1:6110 OLD PLANK RD
Practice Address - Street 2:
Practice Address - City:IRON STATION
Practice Address - State:NC
Practice Address - Zip Code:28080
Practice Address - Country:US
Practice Address - Phone:402-403-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP1237101YA0400X
NC17023101YM0800X
NE1169101YA0400X
NE1767101YM0800X, 101YP2500X
NEP10454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health