VICTA LLC
NPI 1104317007
Internal Medicine - Addiction Medicine in Providence, RI

Q: What is Victa LLC's NPI number?

The NPI number for Victa LLC is 1104317007. It was assigned to this organization in the NPPES registry on May 25, 2018.

Q: What is Victa LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Q: When was this NPI record last updated?

The NPPES record for Victa LLC was last updated on June 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 60 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 25, 2018CLIA Certified · 2 labs

110 ELMWOOD AVE # A, PROVIDENCE, RI 02907(401) 868-0654 Get Directions Write a Review

NPPES record last updated: June 8, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 23, 2026, Dec 10, 2025, Feb 21, 2019 and 2 more (5 updates tracked since 2018).

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About Victa Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VICTA LLC (NPI 1104317007) is a healthcare organization registered as an addiction medicine in Providence, Rhode Island and active in the NPI registry since May 2018. The organization holds 2 active CLIA laboratory certificates and lists Alexander Donoyan, Ceo, as its authorized official.

NPPES Registry Identity

NPI1104317007

Entity TypeOrganization

Primary Taxonomy207RA0401X

Legal Business NameVICTA LLC

Location Address110 ELMWOOD AVE # AProvidence, RI 02907

Mailing Address110 Elmwood AveProvidence, RI 02907-2423 · (401) 300-5757 · Fax (401) 300-5656

Phone(401) 868-0654

Organization SubpartNo

Authorized OfficialAlexander DonoyanCeo · (401) 300-5757

Enumeration DateMay 25, 2018

Last NPPES UpdateJune 8, 20265 updates tracked since enumeration

NPPES CertifiedJune 8, 2026

✔ NPI 1104317007 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 14

★ Primary SpecialtyInternal Medicine · Addiction MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207RA0401X

Definition

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.

Also ListedCounselorTaxonomy 101Y00000X

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

Also ListedPsychologist · Addiction (Substance Use Disorder)Taxonomy 103TA0400X

Also ListedPsychologist · CounselingTaxonomy 103TC1900X

Also ListedMarriage & Family TherapistTaxonomy 106H00000X

Also ListedRegistered Nurse · Addiction (Substance Use Disorder)Taxonomy 163WA0400X

Also ListedRegistered Nurse · Ambulatory CareTaxonomy 163WP2201X

Also ListedCommunity Health WorkerTaxonomy 172V00000X

Also ListedPeer SpecialistTaxonomy 175T00000X

Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X · License 648.01 (RI)

Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X · License 648.01 (RI)

110 ELMWOOD AVE # A, Providence, RI 02907

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 41D2154689

Victa, LLC · Providence, RI

Active · expires Sep 17, 2026

CLIA Number41D2154689

Laboratory TypeCommunity Clinic

Certificate Effective DateSeptember 18, 2024

Certificate Expiration DateSeptember 17, 2026

Laboratory DirectorLisa A. Peterson

Laboratory Phone(401) 300-5757

Laboratory LocationVicta, LLC110 Elmwood Ave, Providence, RI 02907

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 41D2321066

Victa, LLC · Providence, RI

Active · expires Mar 27, 2027

CLIA Number41D2321066

Laboratory TypeCommunity Clinic

Certificate Effective DateMarch 28, 2025

Certificate Expiration DateMarch 27, 2027

Laboratory DirectorLisa A. Peterson

Laboratory Phone(401) 300-5757

Laboratory LocationVicta, LLC45 Willard Ave Ste 2, Providence, RI 02905

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opi G2068

Medication Assisted Treatment (MAT) is a comprehensive approach to managing opioid addiction. It includes a weekly program of buprenorphine medication, personal and group therapy, substance use counseling, and, if necessary, toxicology testing. This service is provided by a Medicare-enrolled opioid treatment provider.

325 services13 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Victa LLC's NPI number?

The NPI number for Victa LLC is 1104317007. It was assigned to this organization in the NPPES registry on May 25, 2018.

Where is Victa LLC located?

Victa LLC is located at 110 Elmwood Ave # A, Providence, RI 02907. The listed phone number is (401) 868-0654.

What is Victa LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Does Victa LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Victa LLC accept?

Health plans from Harvard Pilgrim Health Care list Victa LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Victa LLC was last updated on June 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 60 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.