Provider Demographics
NPI:1710183959
Name:MORRISSETTE, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:MORRISSETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:1009 DARWIN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2026
Mailing Address - Country:US
Mailing Address - Phone:218-791-3020
Mailing Address - Fax:
Practice Address - Street 1:1407 24TH AVE S
Practice Address - Street 2:#206
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6761
Practice Address - Country:US
Practice Address - Phone:218-791-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health