Provider Demographics
NPI:1154735801
Name:VICTORY COUNSELING AND PSYCHOSOCIAL EDUCATION INC
Entity type:Organization
Organization Name:VICTORY COUNSELING AND PSYCHOSOCIAL EDUCATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LITVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-769-6921
Mailing Address - Street 1:6229 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2919
Mailing Address - Country:US
Mailing Address - Phone:818-769-6921
Mailing Address - Fax:
Practice Address - Street 1:6229 MORSE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2919
Practice Address - Country:US
Practice Address - Phone:818-769-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15025261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY150250Medicaid