Provider Demographics
NPI:1073179628
Name:DOMANGUE, VICTORIA C (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:C
Last Name:DOMANGUE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PICONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7051
Mailing Address - Country:US
Mailing Address - Phone:985-860-3752
Mailing Address - Fax:985-208-3051
Practice Address - Street 1:108 PICONE RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7051
Practice Address - Country:US
Practice Address - Phone:985-860-3752
Practice Address - Fax:985-208-3051
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-369103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst