Provider Demographics
NPI:1538902853
Name:PETERSEN, VICTORIA LEIGH (CACD-R, CRM)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEIGH
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:CACD-R, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 NW 5TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4849
Mailing Address - Country:US
Mailing Address - Phone:541-286-4010
Mailing Address - Fax:541-286-4011
Practice Address - Street 1:310 NW 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4849
Practice Address - Country:US
Practice Address - Phone:541-286-4010
Practice Address - Fax:541-286-4011
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)