Provider Demographics
NPI:1811219546
Name:BURKE, VICTORIA LYNNE (CADC, LCSW, LCDP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:CADC, LCSW, LCDP
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:LYNNE
Other - Last Name:BURKE-WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC, LCSW, LCDP
Mailing Address - Street 1:700 GREEN GIANT RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-9630
Mailing Address - Country:US
Mailing Address - Phone:302-376-0809
Mailing Address - Fax:
Practice Address - Street 1:700 GREEN GIANT RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9630
Practice Address - Country:US
Practice Address - Phone:302-376-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD-0000029101YA0400X
DEQ1-00009421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)