MEDICARE: VICTORY HEALTH SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	10551	LA

General Provider Information

NPI Number	:	1255705901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY HEALTH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2337 LAURELWOOD DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-3045
Country	:	US
Telephone Number	:	318-294-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 LAURELWOOD DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-3045
Country	:	US
Telephone Number	:	318-294-8877
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. AKAMIN VICTOR NKENGAKA
Credential	:	PH.D., ACSW
Telephone Number	:	318-294-8877

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

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