VICTA LLC – NPI #1104317007
Internal Medicine

An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

Health Care Provider Taxonomy Code for Internal Medicine

VICTA LLC is a provider located in PROVIDENCE, RI. NPPES has assigned the NPI number 1104317007 to VICTA LLC on May 25, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RA0401X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Addiction Medicine Keep in mind, having a taxonomy code selected doesn't replace any credentialing or validation process that may be required by law.

The NPI profile was last updated on Mar 23, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for VICTA LLC below.

NPI Profile for
VICTA LLC

NPI Number
1104317007
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
VICTA LLC
Primary location
110 ELMWOOD AVE # A
PROVIDENCE, RI 02907
Phone: (401) 868-0654 Fax:
Mailing address
110 ELMWOOD AVE
PROVIDENCE, RI 02907-2423
Phone: (401) 300-5757 Fax: (401) 300-5656
Organization Subpart
No
Authorized Official
ALEXANDER DONOYAN
CEO
Phone: (401) 300-5757
Updated
Certification Date
Mar 23, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

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

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.