Basic Information
| Provider Information | |||||||||
| NPI: | 1255646030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRILL | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1631 FIRETHORNE PL | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930303218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056253566 | ||||||||
| FaxNumber: | 8056599959 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S. WELLS RD., SUITE 200 | ||||||||
| Address2: | CLINICAS DEL CAMINO REAL, INCORPORATED | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056591740 | ||||||||
| FaxNumber: | 8056599959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 26103 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.