Provider Demographics
NPI:1578066122
Name:MCDONALD, VICTORIA L (LISW-S)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LINGENFELSER
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2639
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5679
Practice Address - Country:US
Practice Address - Phone:614-355-7150
Practice Address - Fax:614-355-7855
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20025201041C0700X
OHI.2002520-SUPV1041C0700X
OHS.1801928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid