Provider Demographics
NPI:1609689421
Name:PAUL-IKHANA, VICTORY
Entity type:Individual
Prefix:
First Name:VICTORY
Middle Name:
Last Name:PAUL-IKHANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 NORTHGATE SQUARE, UNIT 12
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:571-215-6166
Mailing Address - Fax:
Practice Address - Street 1:1419 NORTHGATE SQ UNIT 12
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3735
Practice Address - Country:US
Practice Address - Phone:571-215-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker