Healthcare Provider Details

I. General information

NPI: 1245167543
Provider Name (Legal Business Name): VICTORY VILLAGE MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N DUPONT HWY # 1682
DOVER DE
19901-2006
US

IV. Provider business mailing address

1041 N DUPONT HWY # 1682
DOVER DE
19901-2006
US

V. Phone/Fax

Practice location:
  • Phone: 838-368-2111
  • Fax: 240-332-4586
Mailing address:
  • Phone: 838-368-2111
  • Fax: 240-332-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA A NELSON-LARYEA
Title or Position: DIRECTOR/CEO
Credential: PMHNP
Phone: 838-368-2111