Provider Demographics
NPI:1558945584
Name:KABUNGULU, VICTORIA M (MA, LPC, LPCA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:KABUNGULU
Suffix:
Gender:F
Credentials:MA, LPC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 THOMAS MORE PKWY SUITE 160
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-600-6990
Mailing Address - Fax:
Practice Address - Street 1:350 THOMAS MORE PKWY SUITE 160
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-600-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285254101YM0800X
OHC.2305098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.2002807-TRNEOtherOHIO BOARD OF COUNSELORS, SOCIAL WORKERS, AND MFT