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General NPI Number Information
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NPI Number | 1154070225
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Entity Type | Organization
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Legal Business Name | VICTORS IN EDEN LLC
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 2 SABLE ST
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City | NORWALK
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State | CT
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Zip | 06854
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Country | US
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Telephone | 470-829-1333
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Fax | 404-500-5983
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Provider Business Mailing Address
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Address Line | 4854 OLD NATIONAL HWY STE 167
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City | ATLANTA
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State | GA
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Zip | 30337-6201
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Country | US
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Telephone | 470-829-1333
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Fax | 404-500-5983
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Authorized Official
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Title or Position | OWNER
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Name | SINDY VICTOR
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Credential | BCBA, LBA
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Telephone | 470-829-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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