Provider Demographics
NPI:1265048797
Name:PAYNE, VICTORIA (CAP, ICADC, SAP)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CAP, ICADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7848 PLAYPEN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1420
Mailing Address - Country:US
Mailing Address - Phone:904-472-5310
Mailing Address - Fax:
Practice Address - Street 1:7848 PLAYPEN CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1420
Practice Address - Country:US
Practice Address - Phone:904-472-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLICADC.0100151101YA0400X
FLCAP100281101YA0400X
FLHS-BCP7389101Y00000X
FLSAP174503101YA0400X
FLCAP.0100281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor