MEDICARE: MRS. VICTORIA PAYNE LPC, MCAP, ICADC SAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	SAP174503	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAP.0100281	FL
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP.0101294	FL
4	101YP2500X	Professional Counselor	LPC.0023524	CO
5	101Y00000X	Counselor	HS-BCP7389	FL
6	101YA0400X	Addiction (Substance Use Disorder) Counselor	ICADC.0100151	FL

General Provider Information

NPI Number	:	1265048797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA PAYNE LPC, MCAP, ICADC SAP

Provider Business Mailing Address
First Line	:	1200 RIVERPLACE BLVD STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9092
Country	:	US
Telephone Number	:	904-788-7746
Fax Number	:	386-590-9220

Provider Business Practice Location Address
First Line	:	1200 RIVERPLACE BLVD STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9092
Country	:	US
Telephone Number	:	904-788-7746
Fax Number	:	386-590-9220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	03/24/2026

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