Provider Demographics
NPI:1215144605
Name:DRANE, VICTORIA (LPCA, TCM)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DRANE
Suffix:
Gender:F
Credentials:LPCA, TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 PORTLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212
Mailing Address - Country:US
Mailing Address - Phone:502-501-3788
Mailing Address - Fax:502-999-9910
Practice Address - Street 1:2512 PORTLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212
Practice Address - Country:US
Practice Address - Phone:502-501-3788
Practice Address - Fax:502-999-9910
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY290032101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200513310Medicaid