Provider Demographics
NPI:1669951463
Name:SMITH, VICTORIA LYNN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
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 1:123 BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-6466
Mailing Address - Country:US
Mailing Address - Phone:845-797-4820
Mailing Address - Fax:845-724-7160
Practice Address - Street 1:24 AUSTIN CT FL 2
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3628
Practice Address - Country:US
Practice Address - Phone:845-206-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
997980OtherNATIONAL BOARD OF CERTIFIED COUNSELORS