Organization
VICTORIOUS LIFESTYLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAREKA SHERROD (OWNER)
(240) 397-0554
Entity
Organization
Contact information
Practice address
10000 N 31ST AVE STE C307, PHOENIX, AZ 85051-9569
(240) 397-0554
Mailing address
1831 E APACHE BLVD APT 2098, TEMPE, AZ 85281-6682
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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