Provider Demographics
NPI:1972723401
Name:WISE, VICTORIA J (LICSW ACSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:WISE
Suffix:
Gender:F
Credentials:LICSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17220 127TH PL NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7965
Mailing Address - Country:US
Mailing Address - Phone:425-485-9854
Mailing Address - Fax:425-485-9841
Practice Address - Street 1:17220 127TH PL NE
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7965
Practice Address - Country:US
Practice Address - Phone:425-485-9854
Practice Address - Fax:425-485-9841
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALW000070021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical