Individual
MRS. KELLY JOSEPHINE VICTORINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1650 S TOPAZ WAY, MERIDIAN, ID 83642-4474
(208) 888-3151
(208) 888-0854
Mailing address
1650 S TOPAZ WAY, MERIDIAN, ID 83642-4474
(208) 888-3151
(208) 888-0854
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-30564
ID
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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