Provider Demographics
NPI:1801269741
Name:BENTLEY, VICTORIA LYNN (LMHC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17064 PENROD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1235
Mailing Address - Country:US
Mailing Address - Phone:865-748-3599
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST STE 106
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:781-666-2711
Practice Address - Fax:781-666-2712
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-31
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC12970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health