Provider Demographics
NPI:1568698256
Name:WING, VICTORIA GRACE (LPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:WING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MAYS ST
Mailing Address - Street 2:STE. 105-B
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6732
Mailing Address - Country:US
Mailing Address - Phone:512-294-8043
Mailing Address - Fax:
Practice Address - Street 1:1001 S MAYS ST
Practice Address - Street 2:STE. 105-B
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6732
Practice Address - Country:US
Practice Address - Phone:512-294-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211652702Medicaid