Healthcare Provider Details

I. General information

NPI: 1467086322
Provider Name (Legal Business Name): VICTORIA A ROELENS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 W SAN BERNARDINO RD APT 253
COVINA CA
91722-4405
US

IV. Provider business mailing address

200 E ROWLAND ST # 1090
COVINA CA
91723-3146
US

V. Phone/Fax

Practice location:
  • Phone: 909-235-9490
  • Fax:
Mailing address:
  • Phone: 909-235-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: