Healthcare Provider Details

I. General information

NPI: 1053015297
Provider Name (Legal Business Name): VICTORIA FLEMING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY
NEWPORT RI
02840-1735
US

IV. Provider business mailing address

PO BOX 3080
NEWPORT RI
02840-0319
US

V. Phone/Fax

Practice location:
  • Phone: 860-999-1257
  • Fax:
Mailing address:
  • Phone: 847-412-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VICTORIA MANION FLEMING
Title or Position: MEMBER
Credential: PHD, LCPC
Phone: 847-412-8000