Provider Demographics
NPI:1790316081
Name:POPE, VICTORIA TAYLOR
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TAYLOR
Last Name:POPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVERBEND TRL NE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-6122
Mailing Address - Country:US
Mailing Address - Phone:423-650-5888
Mailing Address - Fax:
Practice Address - Street 1:6339 CHARLOTTE PIKE # 696
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2926
Practice Address - Country:US
Practice Address - Phone:407-801-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician