Provider Demographics
NPI:1518791128
Name:THOMPSON, VICTORIA LEE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SHAPPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4066 ENGLISH CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5746
Mailing Address - Country:US
Mailing Address - Phone:609-846-5745
Mailing Address - Fax:
Practice Address - Street 1:1103 W SHERMAN AVE STE 1A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6912
Practice Address - Country:US
Practice Address - Phone:856-240-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-24-74837103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst