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General NPI Number Information
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NPI Number | 1891179776
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Entity Type | Organization
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Legal Business Name | VICTORIA COUNSELING SERVICES INC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 114 KELBER DR
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1275
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Country | US
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Telephone | 508-826-9488
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Fax |
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Provider Business Mailing Address
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Address Line | 320 BOLTON ST SUITE 204
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3988
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Country | US
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Telephone | 508-826-9488
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Fax |
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Authorized Official
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Title or Position | NJURSE PRACTITIONER
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Name | JOSEPHINE BANIGO
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Credential | NP
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Telephone | 508-826-9488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 218062
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License Number State | MA
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