Provider Demographics
NPI:1265975650
Name:WHITE EAGLE HAHN, VICTORIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:WHITE EAGLE HAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S ASBURY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2243
Mailing Address - Country:US
Mailing Address - Phone:208-882-2566
Mailing Address - Fax:
Practice Address - Street 1:530 S ASBURY ST STE 4
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2243
Practice Address - Country:US
Practice Address - Phone:208-882-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-40439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker