Provider Demographics
NPI:1285285379
Name:BROCK, VICTORIA (LIMHP, LADC, CPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:LIMHP, LADC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 COLBY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3044
Mailing Address - Country:US
Mailing Address - Phone:402-499-4028
Mailing Address - Fax:
Practice Address - Street 1:5351 COLBY ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3044
Practice Address - Country:US
Practice Address - Phone:402-499-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1050101YA0400X
NE2231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)