Provider Demographics
NPI:1265183214
Name:CORONADO, VICTORIA JANE (LPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JANE
Last Name:CORONADO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 WELLS BRANCH PKWY APT 931
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6625
Mailing Address - Country:US
Mailing Address - Phone:512-563-1899
Mailing Address - Fax:
Practice Address - Street 1:3101 WELLS BRANCH PKWY APT 931
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6625
Practice Address - Country:US
Practice Address - Phone:512-563-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health