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General NPI Number Information
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NPI Number | 1962194779
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Entity Type | Organization
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Legal Business Name | VICTORIA V, LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 10560 MAIN ST STE 315
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City | FAIRFAX
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State | VA
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Zip | 22030-7175
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Country | US
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Telephone | 703-688-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 25275 KENNEBEC DR
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City | SOUTH RIDING
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State | VA
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Zip | 20152-4468
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA VAN LEEUWEN
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Credential |
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Telephone | 703-501-4795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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