Provider Demographics
NPI:1962566356
Name:WITT, VICTORIA (PHD, MS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4729
Mailing Address - Country:US
Mailing Address - Phone:985-502-3452
Mailing Address - Fax:985-624-4866
Practice Address - Street 1:687 MARILYN DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4729
Practice Address - Country:US
Practice Address - Phone:985-502-3452
Practice Address - Fax:985-624-4866
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003544103TC0700X
LA636103TC0700X
LA636-000032103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010283078Medicaid