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General NPI Number Information
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NPI Number | 1154987907
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Entity Type | Organization
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Legal Business Name | VICTORY COUNSELING AND WELLNESS, LLC.
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 1601 MOTOR INN DR STE 215
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City | GIRARD
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State | OH
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Zip | 44420-2482
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Country | US
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Telephone | 330-519-7543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2281
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-0281
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Country | US
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Telephone | 330-519-7543
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | LORI M HAMILTON
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Credential | LISW-S
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Telephone | 330-519-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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