Provider Demographics
NPI:1790384337
Name:SAM-KPAKRA, VICTORIA N
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:SAM-KPAKRA
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 1:5745 BOZEMAN DR APT 8323
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5793
Mailing Address - Country:US
Mailing Address - Phone:240-350-6415
Mailing Address - Fax:
Practice Address - Street 1:5680 FRISCO SQUARE BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3319
Practice Address - Country:US
Practice Address - Phone:469-535-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional