Provider Demographics
NPI:1750826657
Name:BOURNE, VICTORIA (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 S PRINCE CT
Mailing Address - Street 2:#302
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2915
Mailing Address - Country:US
Mailing Address - Phone:720-526-0825
Mailing Address - Fax:
Practice Address - Street 1:4920 S PRINCE CT
Practice Address - Street 2:#302
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2915
Practice Address - Country:US
Practice Address - Phone:720-526-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099241701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical