Basic Information
| Provider Information | |||||||||
| NPI: | 1902253354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUADRIO | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUDA | ||||||||
| OtherFirstName: | VICTORIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1922 BROOKWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480734180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2493963837 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30701 WOODWARD AVE | ||||||||
| Address2: | 200 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482889333 | ||||||||
| FaxNumber: | 2482881362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2016 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401013396 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6401017284 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.