Provider Demographics
NPI:1750685723
Name:OCHOA, VICKI J (MSSA, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:J
Last Name:OCHOA
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FOREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4057
Mailing Address - Country:US
Mailing Address - Phone:803-451-3975
Mailing Address - Fax:803-931-8959
Practice Address - Street 1:3085 W MARKET ST
Practice Address - Street 2:101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3652
Practice Address - Country:US
Practice Address - Phone:330-835-1468
Practice Address - Fax:330-835-1507
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00052621041C0700X
SC125501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical