MEDICARE: VICTORIA MEXCUR MS. ED, LIMHP, LADC,

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	P1237	NE
2	101YM0800X	Mental Health Counselor	17023	NC
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1169	NE
4	101YM0800X	Mental Health Counselor	1767	NE
5	101YP2500X	Professional Counselor	1767	NE
6	101YP2500X	Professional Counselor	P10454	NE

General Provider Information

NPI Number	:	1417357120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MEXCUR MS. ED, LIMHP, LADC,

Provider Business Mailing Address
First Line	:	6140 OLD PLANK RD
Second Line	:
City	:	IRON STATION
State	:	NC
Zip	:	28080-9214
Country	:	US
Telephone Number	:	402-403-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 OLD PLANK RD
Second Line	:
City	:	IRON STATION
State	:	NC
Zip	:	28080
Country	:	US
Telephone Number	:	402-403-9561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	05/27/2022

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