Provider Demographics
NPI:1689489494
Name:FORD, VICTORIA ANN (DPA, LMSW)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:DPA, LMSW
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:MAFFETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPA LMSW
Mailing Address - Street 1:4606 KEMP DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3016
Mailing Address - Country:US
Mailing Address - Phone:423-394-3733
Mailing Address - Fax:
Practice Address - Street 1:4606 KEMP DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3016
Practice Address - Country:US
Practice Address - Phone:423-394-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126488104100000X
TN13994104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker