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General NPI Number Information
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NPI Number | 1134769268
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Entity Type | Individual
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Provider Name | VIKTORIA KRISTBERGS LCADC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 10 SOMERDALE SQUARE 1200 SOUTH WHITE HORSE PIKE
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City | SOMERDALE
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State | NJ
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Zip | 08083-1345
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Country | US
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Telephone | 856-679-2500
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Fax | 856-282-1608
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Provider Business Mailing Address
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Address Line | 2701 RENAISSANCE BLVD FL 4
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2781
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Country | US
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Telephone | 484-803-9663
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Fax | 484-393-4096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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