Provider Demographics
NPI:1972605103
Name:REITER, VIKKI L (MSSW LCSW LCAC)
Entity Type:Individual
Prefix:
First Name:VIKKI
Middle Name:L
Last Name:REITER
Suffix:
Gender:F
Credentials:MSSW LCSW LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4326
Mailing Address - Country:US
Mailing Address - Phone:812-204-7166
Mailing Address - Fax:812-288-8032
Practice Address - Street 1:534 E COURT AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4028
Practice Address - Country:US
Practice Address - Phone:812-204-7166
Practice Address - Fax:812-288-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004998A1041C0700X
IN87000135A101YA0400X
KY38221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000519424OtherANTHEM
IN11505296OtherCAQH
IN839090YYYMedicare ID - Type Unspecified
IN11505296OtherCAQH