Provider Demographics
NPI:1124755798
Name:CAPTAIN, VICTORIA
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:
Last Name:CAPTAIN
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 1:13059 OLD ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7740
Mailing Address - Country:US
Mailing Address - Phone:301-525-4887
Mailing Address - Fax:
Practice Address - Street 1:13059 OLD ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7740
Practice Address - Country:US
Practice Address - Phone:301-525-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician