Provider Demographics
NPI:1295307916
Name:FLORENCE, VICTORIA ELAINE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LOCUST ST STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1366
Mailing Address - Country:US
Mailing Address - Phone:816-730-8525
Mailing Address - Fax:
Practice Address - Street 1:1300 LOCUST ST STE C
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1366
Practice Address - Country:US
Practice Address - Phone:816-730-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician