Provider Demographics
NPI:1568518785
Name:KOLCH, VICTOR FREDERICK (D MIN)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:FREDERICK
Last Name:KOLCH
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3608
Mailing Address - Country:US
Mailing Address - Phone:260-422-8556
Mailing Address - Fax:260-422-8558
Practice Address - Street 1:300 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3608
Practice Address - Country:US
Practice Address - Phone:260-422-8556
Practice Address - Fax:260-422-8558
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003224A101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral