Healthcare Provider Details

I. General information

NPI: 1902253354
Provider Name (Legal Business Name): VICTORIA CUADRIO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA DUDA

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30701 WOODWARD AVE 200
ROYAL OAK MI
48073-0987
US

IV. Provider business mailing address

1922 BROOKWOOD AVE
ROYAL OAK MI
48073-4180
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-9333
  • Fax: 248-288-1362
Mailing address:
  • Phone: 249-396-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401013396
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: