Provider Demographics
NPI:1659686483
Name:THE VICTORY CENTER FOR AUTISM & BEHAVIORAL CHALLENGES
Entity Type:Organization
Organization Name:THE VICTORY CENTER FOR AUTISM & BEHAVIORAL CHALLENGES
Other - Org Name:THE VICTORY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:THALYA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-466-1142
Mailing Address - Street 1:18900 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3207
Mailing Address - Country:US
Mailing Address - Phone:305-466-1142
Mailing Address - Fax:305-466-1143
Practice Address - Street 1:18900 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-3207
Practice Address - Country:US
Practice Address - Phone:305-466-1142
Practice Address - Fax:305-466-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health