Provider Demographics
NPI:1811663750
Name:LITTLETON, VICTORIA NICOLE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NICOLE
Last Name:LITTLETON
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 1:5146 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47022-5002
Mailing Address - Country:US
Mailing Address - Phone:859-359-0722
Mailing Address - Fax:
Practice Address - Street 1:1974 WALTON NICHOLSON PIKE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7906
Practice Address - Country:US
Practice Address - Phone:859-359-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)