Healthcare Provider Details

I. General information

NPI: 1063000610
Provider Name (Legal Business Name): VICTORY FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

IV. Provider business mailing address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-9741
  • Fax: 704-270-6213
Mailing address:
  • Phone: 704-918-9741
  • Fax: 704-270-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SANDRA FRANCIS RETTIS
Title or Position: OWNER / BILINGUAL THERAPIST
Credential: LCSW
Phone: 704-918-9315