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General NPI Number Information
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NPI Number | 1447132949
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Entity Type | Individual
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Provider Name | VICTORIA AUGUST MA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 15320 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2262
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Country | US
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Telephone | 248-852-2107
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 CHAMBERLAIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2608
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Country | US
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Telephone | 718-877-7502
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6352000982
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License Number State | MI
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