MEDICARE: MRS. VICTORIA MARIE BLINK LCAC

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	87900022A	IN

General Provider Information

NPI Number	:	1619508009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA MARIE BLINK LCAC

Provider Business Mailing Address
First Line	:	17272 DONALD CT
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-4621
Country	:	US
Telephone Number	:	219-798-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 JUSTICE WAY RM C0049
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1574
Country	:	US
Telephone Number	:	219-798-3361
Fax Number	:

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

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	09/03/2025

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