Provider Demographics
NPI:1780210344
Name:NEALE, VICTORIA TOADVINE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TOADVINE
Last Name:NEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ELAINE
Other - Last Name:NEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10607 OLD MARSH RD
Mailing Address - Street 2:
Mailing Address - City:BEALETON
Mailing Address - State:VA
Mailing Address - Zip Code:22712-6837
Mailing Address - Country:US
Mailing Address - Phone:571-283-4307
Mailing Address - Fax:
Practice Address - Street 1:7969 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2885
Practice Address - Country:US
Practice Address - Phone:703-792-7800
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional