Provider Demographics
NPI:1518237205
Name:VICTOR, VANESSA LYNN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LYNN
Last Name:VICTOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1101 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4303
Mailing Address - Country:US
Mailing Address - Phone:323-509-6115
Mailing Address - Fax:
Practice Address - Street 1:1101 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4303
Practice Address - Country:US
Practice Address - Phone:323-509-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW31416104100000X
DC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker