Provider Demographics
NPI:1588248702
Name:WINDHAM, VICTORIA HELEN (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:HELEN
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 INDIGO MARKET DR STE 213
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5905
Mailing Address - Country:US
Mailing Address - Phone:973-830-9578
Mailing Address - Fax:
Practice Address - Street 1:1801 INDIGO MARKET DR STE 213
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5905
Practice Address - Country:US
Practice Address - Phone:973-830-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker