=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568962710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA CAMACHO MA,LPC,LMHC,NCC,ACS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2018
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1481 NE HIGHWAY 351
-----------------------------------------------------
City | CROSS CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32628-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-747-0097
-----------------------------------------------------
Fax | 908-282-3356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1481 NE HIGHWAY 351
-----------------------------------------------------
City | CROSS CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32628-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-747-0097
-----------------------------------------------------
Fax | 908-282-3356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MH26956
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00599200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37PC00599200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37PC00599200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MH26956
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH26956
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------