| Alicia A Victory, Psyd, Llc | |
|
101 Walnut Ln Columbia TN 38401 | |
| (615) 625-2117 | |
| (865) 246-2104 |
| Full Name | Alicia A Victory, Psyd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 101 Walnut Ln, Columbia, Tennessee |
| Authorized Official Name and Position | Alicia A Victory (OWNER) |
| Authorized Official Contact | 6156252117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alicia A Victory, Psyd, Llc Po Box 5777 Maryville TN 37802-5777 Ph: (865) 246-2104 | Alicia A Victory, Psyd, Llc 101 Walnut Ln Columbia TN 38401 Ph: (615) 625-2117 |
| NPI Number | 1386130292 |
|---|---|
| Provider Enumeration Date | 07/03/2018 |
| Last Update Date | 09/04/2018 |
| Medicare PECOS PAC ID | 8820348311 |
|---|---|
| Medicare Enrollment ID | O20180904001947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386130292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 3279 (Tennessee) | Primary |
| Provider Name | Alicia Victory |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659541969 PECOS PAC ID: 6608917844 Enrollment ID: I20161118000565 |
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