Provider Demographics
NPI:1447894043
Name:DURANT, VICTORIA ELIZABETH
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:DURANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PIONEER DR UNIT 1603W
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2783
Mailing Address - Country:US
Mailing Address - Phone:818-679-4025
Mailing Address - Fax:
Practice Address - Street 1:345 PIONEER DR UNIT 1603W
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2783
Practice Address - Country:US
Practice Address - Phone:818-679-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty