Provider Demographics
NPI:1598804981
Name:WHITE, VICTORIA STAPP (MFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:STAPP
Last Name:WHITE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41002 COUNTY CENTER DR STE 320
Mailing Address - Street 2:YOUTH HOSPITALIZATION INTERVENTION PROGRAM - RUHS
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6027
Mailing Address - Country:US
Mailing Address - Phone:951-600-6386
Mailing Address - Fax:951-600-6365
Practice Address - Street 1:41002 COUNTY CENTER DR STE 320
Practice Address - Street 2:YOUTH HOSPITALIZATION INTERVENTION PROGRAM - RUHS
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6027
Practice Address - Country:US
Practice Address - Phone:951-600-6386
Practice Address - Fax:951-600-6365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist