1205319175 NPI number — VICTORIOUS LIVING COUNSELING AND CONSULTING LLC

Table of content: (NPI 1205319175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205319175 NPI number — VICTORIOUS LIVING COUNSELING AND CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIOUS LIVING COUNSELING AND CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205319175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7228 CLARCONA OCOEE RD.
Provider Second Line Business Mailing Address:
#275
Provider Business Mailing Address City Name:
CLARCONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-209-8219
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2813 S HIAWASSEE RD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32835-6690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-209-8219
Provider Business Practice Location Address Fax Number:
321-445-5601
Provider Enumeration Date:
09/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNE
Authorized Official First Name:
LETITIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-209-8219

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  10763 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108384700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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