Provider Demographics
NPI:1558915405
Name:CONNER-HEARN, VICTORIA KATE (ALC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KATE
Last Name:CONNER-HEARN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BAGBY DR STE 217
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3706
Mailing Address - Country:US
Mailing Address - Phone:205-572-9886
Mailing Address - Fax:
Practice Address - Street 1:85 BAGBY DR STE 217
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3706
Practice Address - Country:US
Practice Address - Phone:205-572-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3353A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor