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General NPI Number Information
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NPI Number | 1841889995
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Entity Type | Individual
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Provider Name | VITORIA SUPLICY PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 1073 WILLA SPRINGS DR STE 1037
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6624
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Country | US
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Telephone | 404-295-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 WILLA SPRINGS DR STE 1037
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6624
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Country | US
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Telephone | 321-246-5225
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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 | PY10549
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License Number State | FL
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