Provider Demographics
NPI:1922434646
Name:MUHAMMAD, VICTORIA LYLES (LCPC , NCC, IDVCA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYLES
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:LCPC , NCC, IDVCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2528
Mailing Address - Country:US
Mailing Address - Phone:312-972-1955
Mailing Address - Fax:
Practice Address - Street 1:308 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2528
Practice Address - Country:US
Practice Address - Phone:312-972-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003866101YP2500X
IL6805030174251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional