Provider Demographics
NPI:1922120914
Name:FACKOS, VICTORIA ANN (LICSW, LCDCS)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:FACKOS
Suffix:
Gender:F
Credentials:LICSW, LCDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROBERT A WALKER AND ASSOCIATES, COUNSELING AND CONSULTI
Mailing Address - Street 2:1087 WARWICK AVE REAR UNIT
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3545
Mailing Address - Country:US
Mailing Address - Phone:401-383-2200
Mailing Address - Fax:401-256-5209
Practice Address - Street 1:ROBERT A WALKER AND ASSOCIATES, COUNSELING AND CONSULTI
Practice Address - Street 2:1087 WARWICK AVE REAR UNIT
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-383-2200
Practice Address - Fax:401-256-5209
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)