Provider Demographics
NPI:1982847398
Name:WINEBARGER, VICTORIA LOU (LMSW, CAAC, CAADC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOU
Last Name:WINEBARGER
Suffix:
Gender:F
Credentials:LMSW, CAAC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16801 NEWBURGH RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1606
Mailing Address - Country:US
Mailing Address - Phone:734-377-4134
Mailing Address - Fax:
Practice Address - Street 1:16801 NEWBURGH RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1606
Practice Address - Country:US
Practice Address - Phone:734-377-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010784311041C0700X
MIC-01551101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)