Provider Demographics
NPI:1730579673
Name:MCKENNA, VICTORIA ALEXIS
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALEXIS
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8348 TRAFORD LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1663
Mailing Address - Country:US
Mailing Address - Phone:703-866-2121
Mailing Address - Fax:
Practice Address - Street 1:10570 MAIN ST
Practice Address - Street 2:APT 511
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7113
Practice Address - Country:US
Practice Address - Phone:703-895-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist