# VICTA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104317007
- **Authorized official:** MR. ALEXANDER DONOYAN (CEO)
- **Authorized official phone:** (401) 300-5757

## Contact information

- **Practice address:** 110 ELMWOOD AVE \# A, PROVIDENCE, RI 02907
- **Practice address phone:** (401) 868-0654
- **Mailing address:** 110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
- **Mailing address phone:** (401) 300-5757
- **Mailing address fax:** (401) 300-5656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 133NN1002X | Nutrition Education Nutritionist | — | — | — |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse | — | NULL | — |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse | — | — | — |
| 163WP2201X | Ambulatory Care Registered Nurse | — | NULL | — |
| 163WP2201X | Ambulatory Care Registered Nurse | — | — | — |
| 172V00000X | Community Health Worker | — | NULL | — |
| 172V00000X | Community Health Worker | — | — | — |
| 175T00000X | Peer Specialist | — | NULL | — |
| 175T00000X | Peer Specialist | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | 648.01 | RI | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | 648.01 | RI | — |

## Other

- **Enumeration date:** 05/25/2018
- **Last updated:** 06/08/2026