Provider Demographics
NPI:1487062626
Name:CHARLAND, VICTORIA MICHELE DEFALCO (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHELE DEFALCO
Last Name:CHARLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34274-0728
Mailing Address - Country:US
Mailing Address - Phone:941-928-9774
Mailing Address - Fax:
Practice Address - Street 1:11705 EVENING WALK DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-9508
Practice Address - Country:US
Practice Address - Phone:941-423-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical