Basic Information
| Provider Information | |||||||||
| NPI: | 1598804981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | STAPP | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41002 COUNTY CENTER DR STE 320 | ||||||||
| Address2: | YOUTH HOSPITALIZATION INTERVENTION PROGRAM - RUHS | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006386 | ||||||||
| FaxNumber: | 9516006365 | ||||||||
| Practice Location | |||||||||
| Address1: | 41002 COUNTY CENTER DR STE 320 | ||||||||
| Address2: | YOUTH HOSPITALIZATION INTERVENTION PROGRAM - RUHS | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006386 | ||||||||
| FaxNumber: | 9516006365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 25860 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.