Healthcare Provider Details

I. General information

NPI: 1053799908
Provider Name (Legal Business Name): VICTORIA ANN VROOMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 ALU ST
HILO HI
96720-3318
US

IV. Provider business mailing address

PO BOX 7430
HILO HI
96720-8944
US

V. Phone/Fax

Practice location:
  • Phone: 808-640-4492
  • Fax:
Mailing address:
  • Phone: 808-640-4492
  • 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:
Title or Position:
Credential:
Phone: