Provider Demographics
NPI:1780841445
Name:FERDINAND-GANT, VICTORIA LAURA (MS,MFCT, INTERN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LAURA
Last Name:FERDINAND-GANT
Suffix:
Gender:F
Credentials:MS,MFCT, INTERN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LAURA
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10929 SOUTH ST STE 214B
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5374
Mailing Address - Country:US
Mailing Address - Phone:562-865-6444
Mailing Address - Fax:562-865-5864
Practice Address - Street 1:10929 SOUTH ST STE 214B
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5374
Practice Address - Country:US
Practice Address - Phone:562-865-6444
Practice Address - Fax:562-865-5864
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist