Provider Demographics
NPI:1982956009
Name:MOTTER, VICTORIA JEAN (MED NCC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JEAN
Last Name:MOTTER
Suffix:
Gender:F
Credentials:MED NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-6986
Mailing Address - Country:US
Mailing Address - Phone:570-295-4453
Mailing Address - Fax:
Practice Address - Street 1:70 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-6986
Practice Address - Country:US
Practice Address - Phone:570-295-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA201068101Y00000X
187652EDSPECIALIST I101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool