Provider Demographics
NPI:1780928887
Name:SMITH, VICTORIA TORREY C (MA, MFT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TORREY C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E IMPERIAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5601
Mailing Address - Country:US
Mailing Address - Phone:714-213-5367
Mailing Address - Fax:714-256-1768
Practice Address - Street 1:711 E IMPERIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5601
Practice Address - Country:US
Practice Address - Phone:714-213-5367
Practice Address - Fax:714-256-1768
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist