Provider Demographics
NPI:1538432687
Name:VICTORY, JASON ROBERT (MS, NCC, LPC, ACS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:VICTORY
Suffix:
Gender:M
Credentials:MS, NCC, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MARKET ST STE 470
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3241
Mailing Address - Country:US
Mailing Address - Phone:336-740-9693
Mailing Address - Fax:919-797-2644
Practice Address - Street 1:115 MARKET ST STE 470
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3241
Practice Address - Country:US
Practice Address - Phone:336-740-9693
Practice Address - Fax:919-797-2644
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional