Provider Demographics
NPI:1336917210
Name:SMITH, VICTORIA GENEVIEVE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GENEVIEVE
Last Name:SMITH
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 1:10500 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-4215
Mailing Address - Country:US
Mailing Address - Phone:703-946-1823
Mailing Address - Fax:
Practice Address - Street 1:12330 PINECREST RD STE 300
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1642
Practice Address - Country:US
Practice Address - Phone:703-946-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-23-70213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst