Healthcare Provider Details

I. General information

NPI: 1306347521
Provider Name (Legal Business Name): VICTORIA F THOMAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 N 28TH DR BLDG E
PHOENIX AZ
85029-5615
US

IV. Provider business mailing address

4715 E ADOBE DR
PHOENIX AZ
85050-6855
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86025063
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: