Provider Demographics
NPI:1932837432
Name:KIBODEAUX, VICTORIA LYNNETTE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNETTE
Last Name:KIBODEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 MCLEMORE DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5646
Mailing Address - Country:US
Mailing Address - Phone:346-770-7132
Mailing Address - Fax:
Practice Address - Street 1:238 MCLEMORE DR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5646
Practice Address - Country:US
Practice Address - Phone:346-770-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95817101YM0800X
TX16555101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)