Healthcare Provider Details

I. General information

NPI: 1003749995
Provider Name (Legal Business Name): VICTORIA LYNN GARCIA SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W HILDEBRAND BLVD APT C150
KENNEWICK WA
99338-1122
US

IV. Provider business mailing address

7510 W DESCHUTES PL
KENNEWICK WA
99336-7719
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-0738
  • Fax: 509-579-0712
Mailing address:
  • Phone: 509-579-0738
  • Fax: 509-579-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number70008312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: