Provider Demographics
NPI:1821374109
Name:PAINTER, VICTORIA LYNN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:LYNN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:RAF LAKENHEATH 48 MDG
Mailing Address - Street 2:UNIT 5210 BOX 230
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-0230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 W WHITE PINE DR
Practice Address - Street 2:
Practice Address - City:SANTA CLAUS
Practice Address - State:IN
Practice Address - Zip Code:47579-6064
Practice Address - Country:US
Practice Address - Phone:812-686-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006263A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical