Healthcare Provider Details

I. General information

NPI: 1518692409
Provider Name (Legal Business Name): LINCOLN STOLLER PHD, CHT, CCPCPR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGH STREET
VICTORIA BRITISH COLUMBIA
V8Z 5C8
CA

IV. Provider business mailing address

81 HIGH STREET
VICTORIA BRITISH COLUMBIA
V8Z 5C8
CA

V. Phone/Fax

Practice location:
  • Phone: 250-885-8677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3115
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: