Provider Demographics
NPI:1710391537
Name:THOMAS, VICTORIA (IMF)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3240
Mailing Address - Country:US
Mailing Address - Phone:707-422-0464
Mailing Address - Fax:707-422-0465
Practice Address - Street 1:2195 UNION AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3240
Practice Address - Country:US
Practice Address - Phone:707-422-0464
Practice Address - Fax:707-422-0465
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health