Provider Demographics
NPI:1487485801
Name:KRUG, VICTORIA NOREEN (LAC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NOREEN
Last Name:KRUG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PALLANT AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3654
Mailing Address - Country:US
Mailing Address - Phone:609-384-6313
Mailing Address - Fax:
Practice Address - Street 1:950 KINGS HWY N STE 304
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1518
Practice Address - Country:US
Practice Address - Phone:856-600-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00757500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor