Healthcare Provider Details

I. General information

NPI: 1316341696
Provider Name (Legal Business Name): VICTORIA NICOLE CHENAULT LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26827 AUGUSTINE DR
DAPHNE AL
36526-1035
US

IV. Provider business mailing address

26827 AUGUSTINE DR
DAPHNE AL
36526-1035
US

V. Phone/Fax

Practice location:
  • Phone: 251-635-7500
  • Fax:
Mailing address:
  • Phone: 251-635-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: