| Victory House Llc | |
|
561 Breckenridge St Apt 201 Lexington KY 40508-2256 | |
| (859) 618-7778 | |
| Not Available |
| Full Name | Victory House Llc |
|---|---|
| Speciality | Counselor |
| Location | 561 Breckenridge St Apt 201, Lexington, Kentucky |
| Authorized Official Name and Position | Victor Littleton (OWNER) |
| Authorized Official Contact | 8596187778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory House Llc 561 Breckenridge St Apt 201 Lexington KY 40508-2256 Ph: (859) 618-7778 | Victory House Llc 561 Breckenridge St Apt 201 Lexington KY 40508-2256 Ph: (859) 618-7778 |
| NPI Number | 1033898853 |
|---|---|
| Provider Enumeration Date | 07/18/2023 |
| Last Update Date | 07/18/2023 |
| Certification Date | 07/18/2023 |
| Medicare PECOS PAC ID | 4082078696 |
|---|---|
| Medicare Enrollment ID | O20230915001036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033898853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Youlonda Candida Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689359200 PECOS PAC ID: 1153785779 Enrollment ID: I20230915001146 |
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