Provider Demographics
NPI:1487113387
Name:STANTON, VICTORIA (LCPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PLEASANT RUN DR APT 805
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5611
Mailing Address - Country:US
Mailing Address - Phone:510-822-1388
Mailing Address - Fax:
Practice Address - Street 1:5214 N WESTERN AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2588
Practice Address - Country:US
Practice Address - Phone:773-250-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional