Provider Demographics
NPI:1356788905
Name:KORGE, VICTORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:KORGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1206 MAMALAHOA HWY
Mailing Address - Street 2:# 1-205
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7303
Mailing Address - Country:US
Mailing Address - Phone:808-885-7444
Mailing Address - Fax:808-885-0716
Practice Address - Street 1:65-1206 MAMALAHOA HWY
Practice Address - Street 2:# 1-205
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7303
Practice Address - Country:US
Practice Address - Phone:808-885-7444
Practice Address - Fax:808-885-0716
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1195103TC0700X
TX31115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical