Provider Demographics
NPI:1659541969
Name:VICTORY, ALICIA ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANNE
Last Name:VICTORY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4943
Mailing Address - Country:US
Mailing Address - Phone:615-625-2117
Mailing Address - Fax:615-373-8216
Practice Address - Street 1:101 WALNUT LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4943
Practice Address - Country:US
Practice Address - Phone:615-625-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical