Provider Demographics
NPI:1598379778
Name:TROFIMOVICH, VICKI ALEXANDRA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:ALEXANDRA
Last Name:TROFIMOVICH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:TROFIMOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1621 SEATTLE HILL RD APT B3
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4101
Mailing Address - Country:US
Mailing Address - Phone:253-306-8372
Mailing Address - Fax:
Practice Address - Street 1:1621 SEATTLE HILL RD APT B3
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-4101
Practice Address - Country:US
Practice Address - Phone:253-306-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608418651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty