Provider Demographics
NPI:1942937032
Name:BETHEL, VICTORIA ELISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ELISE
Last Name:BETHEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 HARLEQUIN WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4225
Mailing Address - Country:US
Mailing Address - Phone:615-800-0177
Mailing Address - Fax:
Practice Address - Street 1:1484 HARLEQUIN WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4225
Practice Address - Country:US
Practice Address - Phone:615-800-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical