Provider Demographics
NPI:1508013137
Name:LIGHTCAP, VICTORIA ANNE (MS, LMFTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:LIGHTCAP
Suffix:
Gender:F
Credentials:MS, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 INLAND TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5907
Mailing Address - Country:US
Mailing Address - Phone:260-405-8471
Mailing Address - Fax:
Practice Address - Street 1:3948 NEW VISION DR STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1721
Practice Address - Country:US
Practice Address - Phone:260-407-7285
Practice Address - Fax:260-407-0094
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist