NPI Index

VICTA LLC

Internal Medicine - Addiction Medicine

Active Organization
NPI: 1104317007

Practice Address

110 ELMWOOD AVE # A
Providence, RI 02907

Phone: (401) 868-0654

Specialties

Specialty Code Primary License
Internal Medicine - Infectious Disease 207RI0200X No -
Clinic/Center - Mental Health (Including Community Mental Health Center) 261QM0801X No 648.01 (RI)
Clinic/Center - Rehabilitation, Substance Use Disorder 261QR0405X No 648.01 (RI)
Counselor 101Y00000X No -
Counselor - Addiction (Substance Use Disorder) 101YA0400X No -
Counselor - Mental Health 101YM0800X No -
Psychologist - Addiction (Substance Use Disorder) 103TA0400X No -
Psychologist - Counseling 103TC1900X No -
Marriage & Family Therapist 106H00000X No -
Nutritionist - Nutrition, Education 133NN1002X No -
Registered Nurse - Addiction (Substance Use Disorder) 163WA0400X No -
Registered Nurse - Ambulatory Care 163WP2201X No -
Internal Medicine - Addiction Medicine 207RA0401X Yes -

Frequently Asked Questions

NPI 1104317007 is the National Provider Identifier for VICTA LLC, a Internal Medicine - Addiction Medicine provider located in Providence, RI. This NPI was enumerated on May 25, 2018.

Quick Facts

NPI
1104317007
Type
Organization
Enumerated
May 25, 2018
Last Updated
Dec 10, 2025

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