Provider Demographics
NPI:1366886087
Name:DILLARD, VICTORIA (LBP,LPC,LADC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LBP,LPC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12306 S 13TH ST E
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:OK
Mailing Address - Zip Code:74469-8010
Mailing Address - Country:US
Mailing Address - Phone:918-441-7775
Mailing Address - Fax:918-989-5544
Practice Address - Street 1:12306 S 13TH ST E
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469-8010
Practice Address - Country:US
Practice Address - Phone:918-441-7775
Practice Address - Fax:918-989-5544
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29101YA0400X
OK3071101YP2500X
OK0051103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional