Provider Demographics
NPI:1447733209
Name:STANTON, VICTORIA FRANCES (LEP, PPS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:FRANCES
Last Name:STANTON
Suffix:
Gender:F
Credentials:LEP, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8366
Mailing Address - Country:US
Mailing Address - Phone:530-268-3700
Mailing Address - Fax:530-268-8372
Practice Address - Street 1:11130 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8366
Practice Address - Country:US
Practice Address - Phone:530-268-3700
Practice Address - Fax:530-268-8372
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2876103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2876OtherCALIFORNIA BBS