Healthcare Provider Details

I. General information

NPI: 1902535537
Provider Name (Legal Business Name): VICTORIA JOAN FICK ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/13/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9392
  • Fax:
Mailing address:
  • Phone: 562-981-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW105151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: