Provider Demographics
NPI:1598257529
Name:THOMPSON, VICTORIA ILENE
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ILENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:ILENE
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5610 CRAWFORDSVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3714
Mailing Address - Country:US
Mailing Address - Phone:317-241-4673
Mailing Address - Fax:317-241-0201
Practice Address - Street 1:5610 CRAWFORDSVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3714
Practice Address - Country:US
Practice Address - Phone:317-241-4673
Practice Address - Fax:317-241-0201
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor