Healthcare Provider Details

I. General information

NPI: 1114781390
Provider Name (Legal Business Name): VICTORY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROBIN RD STE 1002
ALTAMONTE SPRINGS FL
32701-5035
US

IV. Provider business mailing address

1713 BILLIE LYNN PT
SANFORD FL
32773-7049
US

V. Phone/Fax

Practice location:
  • Phone: 689-777-3152
  • Fax:
Mailing address:
  • Phone: 689-777-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICIA AVALOS
Title or Position: OWNER
Credential: LMHC
Phone: 689-777-3152