Healthcare Provider Details

I. General information

NPI: 1144165580
Provider Name (Legal Business Name): VICTORIA ROQUE LPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SPRINGHALL DR STE A
GOOSE CREEK SC
29445-5360
US

IV. Provider business mailing address

118 SPRINGHALL DR STE A
GOOSE CREEK SC
29445-5360
US

V. Phone/Fax

Practice location:
  • Phone: 843-376-3112
  • Fax: 843-594-0110
Mailing address:
  • Phone: 843-376-3112
  • Fax: 843-594-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4882
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: