Healthcare Provider Details

I. General information

NPI: 1104591080
Provider Name (Legal Business Name): VICTORIA DENISE WEEKS EVANS BEHAVIOR ANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30205 TAVARES RIDGE BLVD
TAVARES FL
32778-4465
US

IV. Provider business mailing address

30205 TAVARES RIDGE BLVD
TAVARES FL
32778-4465
US

V. Phone/Fax

Practice location:
  • Phone: 352-874-9802
  • Fax:
Mailing address:
  • Phone: 352-874-9802
  • Fax: 352-388-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: