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General NPI Number Information
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NPI Number | 1174972251
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Entity Type | Organization
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Legal Business Name | VICTORIA ENTERPRISES
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 8501 WOODFORD BRIDGE DR
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City | CHARLOTTE
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State | NC
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Zip | 28216-9680
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Country | US
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Telephone | 704-975-4854
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Fax |
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Provider Business Mailing Address
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Address Line | 8501 WOODFORD BRIDGE DR
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City | CHARLOTTE
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State | NC
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Zip | 28216-9680
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Country | US
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Telephone | 704-975-4854
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FLOYD MORRIS LONG III
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Credential | OWNER
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Telephone | 704-975-4854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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