Provider Demographics
NPI:1629379219
Name:VICTORIA ALBANESE, LCSW, LLC
Entity Type:Organization
Organization Name:VICTORIA ALBANESE, LCSW, LLC
Other - Org Name:VICTORIA ALBANESE, LCSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:BANKOV
Authorized Official - Last Name:ALBANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:706-338-9685
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650
Mailing Address - Country:US
Mailing Address - Phone:706-338-9685
Mailing Address - Fax:706-310-7044
Practice Address - Street 1:47 GREENSBORO HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2515
Practice Address - Country:US
Practice Address - Phone:706-338-9685
Practice Address - Fax:706-310-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW00032221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA724018799BMedicaid