Victory, Marisa Helena
Victory, Marisa Helena is an sole proprietor health care provider with primary practice located at 2100 N Main St Ste 304 , Crown Point IN 46307-1877. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Victory, Marisa Helena can be contacted via phone (745) 461-9005.Contact Information
Primary practice address
2100 N Main St Ste 304
Crown Point IN 46307-1877
Phone: (745) 461-9005
Fax: (574) 546-1999
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 39154 | Texas |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | S.0901121 | Ohio |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | I.1201235 | Ohio |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20043650B | Indiana |
Profile Details
| NPI number | 1902120629 |
|---|---|
| LBN Legal business name | Victory, Marisa Helena |
| Credentials | PSY.D., MA, MSW |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 24th, 2010 |
| Last updated | Mar 14th, 2024 - about 9 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902120629 | NPPES |
| Ohio | Other | P.085240 | STATE LICENSE |
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