Provider Demographics
NPI:1124781364
Name:VICTORY PSYCH CONSULTATION SERVICES
Entity type:Organization
Organization Name:VICTORY PSYCH CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:YAHAYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANIMASHAUN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:908-247-8768
Mailing Address - Street 1:10 ETON DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2482
Mailing Address - Country:US
Mailing Address - Phone:908-247-8768
Mailing Address - Fax:646-490-8780
Practice Address - Street 1:188 FRIES MILL RD STE E2
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:551-214-4475
Practice Address - Fax:646-490-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty