Provider Demographics
NPI:1760014419
Name:BURTON, VICTORIA MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHELLE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MICHELLE
Other - Last Name:CADOTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5605
Mailing Address - Country:US
Mailing Address - Phone:313-405-0525
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5605
Practice Address - Country:US
Practice Address - Phone:313-405-0525
Practice Address - Fax:586-466-4143
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801114569101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor