Provider Demographics
NPI:1518017250
Name:LEISURE, VICTORIA PARKER (MS, LPC, CAC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PARKER
Last Name:LEISURE
Suffix:
Gender:F
Credentials:MS, LPC, CAC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, CAC
Mailing Address - Street 1:668 LAUREL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-9791
Mailing Address - Country:US
Mailing Address - Phone:717-372-8181
Mailing Address - Fax:717-664-2846
Practice Address - Street 1:2461 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3670
Practice Address - Country:US
Practice Address - Phone:717-475-0882
Practice Address - Fax:717-560-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACAC0898101YA0400X
PAPC001680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50046062OtherCAPITAL BLUE CROSS ID
PA520817OtherVALUEOPTIONS ID
PA11615745OtherCAQH NUMBER