Provider Demographics
NPI:1942693627
Name:SLUGA, VICTORIA (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SLUGA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-258-7543
Mailing Address - Fax:616-389-1069
Practice Address - Street 1:300 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4101
Practice Address - Country:US
Practice Address - Phone:616-258-7543
Practice Address - Fax:616-389-1069
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker