Healthcare Provider Details

I. General information

NPI: 1306078100
Provider Name (Legal Business Name): V I C (VICTORY IN CRISIS), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MARTIN LUTHER KING PKWY SUITE 201
DURHAM NC
27707-3500
US

IV. Provider business mailing address

PO BOX 11599
DURHAM NC
27703-0599
US

V. Phone/Fax

Practice location:
  • Phone: 919-641-5722
  • Fax:
Mailing address:
  • Phone: 919-641-5722
  • Fax: 919-490-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. TANYA DANIELLA MELTON
Title or Position: PRESIDENT
Credential:
Phone: 919-641-5722