Provider Demographics
NPI:1174129316
Name:THOMPSON, VICTORIA SNIDER (PHD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SNIDER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1151 DOVE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2805
Mailing Address - Country:US
Mailing Address - Phone:949-756-8446
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2805
Practice Address - Country:US
Practice Address - Phone:949-756-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14088103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist