Provider Demographics
NPI:1144950676
Name:EVANS-FULTON, VICTORIA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:EVANS-FULTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0544
Mailing Address - Country:US
Mailing Address - Phone:276-477-4174
Mailing Address - Fax:
Practice Address - Street 1:26108 BEECH CIR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7262
Practice Address - Country:US
Practice Address - Phone:276-207-8321
Practice Address - Fax:888-548-4146
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health