Provider Demographics
NPI:1982006177
Name:MEREDITH, VICTORIA (CADC I)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 25TH AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0338
Mailing Address - Country:US
Mailing Address - Phone:503-378-3788
Mailing Address - Fax:503-378-3668
Practice Address - Street 1:4600 25TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0338
Practice Address - Country:US
Practice Address - Phone:503-378-3788
Practice Address - Fax:503-378-3668
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09-09-35101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)