Provider Demographics
NPI:1821650409
Name:SAPP, VICTORIA A (CADC-T (T0307))
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:SAPP
Suffix:
Gender:F
Credentials:CADC-T (T0307)
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 CINDY CIR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8230
Mailing Address - Country:US
Mailing Address - Phone:757-617-6950
Mailing Address - Fax:
Practice Address - Street 1:2007 OLD LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3510
Practice Address - Country:US
Practice Address - Phone:706-861-9390
Practice Address - Fax:706-866-4740
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty