Provider Demographics
NPI:1073368106
Name:KISS, VIKTORIA
Entity type:Individual
Prefix:MS
First Name:VIKTORIA
Middle Name:
Last Name:KISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 B ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3184
Mailing Address - Country:US
Mailing Address - Phone:510-247-8200
Mailing Address - Fax:510-247-8202
Practice Address - Street 1:1866 B ST STE 101
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3184
Practice Address - Country:US
Practice Address - Phone:510-247-8200
Practice Address - Fax:510-247-8202
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor