Provider Demographics
NPI:1053774240
Name:SMITH, VICTORIA MAY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MAY
Other - Last Name:HUCKABEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17909 W LANCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-6002
Mailing Address - Country:US
Mailing Address - Phone:509-944-1094
Mailing Address - Fax:
Practice Address - Street 1:17909 W LANCE HILL RD
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-6002
Practice Address - Country:US
Practice Address - Phone:509-944-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60772902101Y00000X
WACL60633641101YM0800X
WALW611436011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health