Healthcare Provider Details

I. General information

NPI: 1326902271
Provider Name (Legal Business Name): VICTORIA FAYE PHELPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ROSEHILL DR
SOUTH BOSTON VA
24592-4843
US

IV. Provider business mailing address

1340 CHAMBERS LOOP RD
TIMBERLAKE NC
27583-9081
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-4201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30003485
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: