Healthcare Provider Details

I. General information

NPI: 1043731839
Provider Name (Legal Business Name): VICTORIA PENTON APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 OREGON ST STE 216
REDDING CA
96001-1757
US

IV. Provider business mailing address

1650 OREGON ST STE 216
REDDING CA
96001-1757
US

V. Phone/Fax

Practice location:
  • Phone: 556-053-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5874
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5872
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: