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General NPI Number Information
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NPI Number | 1225325442
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Entity Type | Organization
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Legal Business Name | WILLIAM A. VICTOR
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 6 EMERALD TER SUITE 4
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City | SWANSEA
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State | IL
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Zip | 62226-2312
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Country | US
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Telephone | 618-233-0500
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Fax | 618-233-7935
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Provider Business Mailing Address
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Address Line | 4109 BASSEN DR
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City | SWANSEA
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State | IL
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Zip | 62226-7909
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Country | US
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Telephone | 618-516-3337
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Fax | 618-233-7935
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. WILLIAM A VICTOR
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Credential | D.MIN, LCPC
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Telephone | 618-516-3337
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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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