Provider Demographics
NPI:1538107578
Name:MEACHAM, VICTORIA J (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 SPRING BANK DR
Mailing Address - Street 2:STE 1
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7553
Mailing Address - Country:US
Mailing Address - Phone:270-316-7332
Mailing Address - Fax:270-906-1150
Practice Address - Street 1:1401 SPRING BANK DR
Practice Address - Street 2:STE 1
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7553
Practice Address - Country:US
Practice Address - Phone:270-316-7332
Practice Address - Fax:270-906-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY16091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0026918Medicare PIN
KYK059163Medicare PIN