Provider Demographics
NPI:1437352598
Name:COYNE, VICTORIA PAXTON (LPC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:PAXTON
Last Name:COYNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2312
Mailing Address - Country:US
Mailing Address - Phone:313-885-4475
Mailing Address - Fax:
Practice Address - Street 1:20801 MOROSS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2027
Practice Address - Country:US
Practice Address - Phone:313-343-9000
Practice Address - Fax:313-343-9012
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional