Provider Demographics
NPI:1467457168
Name:COAD, VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:COAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:PT RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3950
Mailing Address - Country:US
Mailing Address - Phone:510-233-1992
Mailing Address - Fax:
Practice Address - Street 1:125 W RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:PT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3950
Practice Address - Country:US
Practice Address - Phone:510-233-1992
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical