Provider Demographics
NPI:1912441387
Name:BAASCH, VICTORIA CALLAWAY (RADTI)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:CALLAWAY
Last Name:BAASCH
Suffix:
Gender:F
Credentials:RADTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2640 CAMBRIDGE RD APT 86
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9295
Mailing Address - Country:US
Mailing Address - Phone:916-416-4837
Mailing Address - Fax:
Practice Address - Street 1:2844 COLOMA ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4406
Practice Address - Country:US
Practice Address - Phone:530-626-9240
Practice Address - Fax:530-626-8992
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1224420316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)