Provider Demographics
NPI:1811683451
Name:CROSS, VICTORIA MARIE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:CROSS
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 1:24733 HAVEN PARK ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-1037
Mailing Address - Country:US
Mailing Address - Phone:586-840-6305
Mailing Address - Fax:
Practice Address - Street 1:33464 SCHOENHERR RD STE 180
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6392
Practice Address - Country:US
Practice Address - Phone:586-999-5971
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst