Provider Demographics
NPI:1578779625
Name:CARRELLE, VICTORIA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARIE
Last Name:CARRELLE
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 1:51 WOOD RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2416
Mailing Address - Country:US
Mailing Address - Phone:201-460-8774
Mailing Address - Fax:
Practice Address - Street 1:51 WOOD RIDGE ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2416
Practice Address - Country:US
Practice Address - Phone:201-460-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00355200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional