Provider Demographics
NPI:1255393625
Name:ENDICOTT, VICTORIA FOWLER (MSW, LISW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:FOWLER
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ELLEN KAY DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-382-3874
Mailing Address - Fax:740-382-2930
Practice Address - Street 1:1125 ELLEN KAY DR
Practice Address - Street 2:STE D
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6286
Practice Address - Country:US
Practice Address - Phone:740-381-3874
Practice Address - Fax:740-382-2930
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008766104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker