Healthcare Provider Details

I. General information

NPI: 1538915889
Provider Name (Legal Business Name): VICTORIA IJEOMA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA EKWOROMADU

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NW GREELEY AVE
BEND OR
97703-2943
US

IV. Provider business mailing address

45 NW GREELEY AVE
BEND OR
97703-2943
US

V. Phone/Fax

Practice location:
  • Phone: 541-236-2073
  • Fax: 541-213-2765
Mailing address:
  • Phone: 541-236-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10606
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: