Healthcare Provider Details

I. General information

NPI: 1134769268
Provider Name (Legal Business Name): VIKTORIA KRISTBERGS LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SOMERDALE SQUARE 1200 SOUTH WHITE HORSE PIKE
SOMERDALE NJ
08083-1345
US

IV. Provider business mailing address

2701 RENAISSANCE BLVD FL 4
KING OF PRUSSIA PA
19406-2781
US

V. Phone/Fax

Practice location:
  • Phone: 856-679-2500
  • Fax: 856-282-1608
Mailing address:
  • Phone: 484-803-9663
  • Fax: 484-393-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: