NPIMap

Organization Active NPI

Victa LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Providence, RI
National Provider Identifier
1104317007
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
VICTA LLC
Practice address
110 Elmwood Ave # a
Providence, RI 02907
Phone
(401) 868-0654
NPI assigned
May 25, 2018
Last updated
Jun 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Alexander DonoyanNPI 1316438211
Title
Ceo
Phone
(401) 300-5757

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Addiction (Substance Use Disorder) Psychologist 103TA0400X
Counseling Psychologist 103TC1900X
Marriage & Family Therapist 106H00000X
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X
Ambulatory Care Registered Nurse 163WP2201X
Addiction Medicine (Internal Medicine) Physician 207RA0401X Primary
Infectious Disease Physician 207RI0200X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 648.01 RI
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 648.01 RI
Community Health Worker 172V00000X
Peer Specialist 175T00000X

Addresses

Primary practice location

110 Elmwood Ave # a
Providence, RI 02907

Mailing address

110 Elmwood Ave
Providence, RI 02907-2423
Phone (401) 300-5757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 28, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200415002461 RI Part B Supplier - Clinic/Group Practice 0840620894 Receives reassigned benefits from 8 practitioners
Practice locations: Providence, RI
O20200520002570 RI Part B Supplier - Opioid Treatment Program (Otp) 0840620894 Practice locations: Providence, RI

National Provider Directory

National Provider Directory

Locations

110 Elmwood Ave
#A
Providence, RI 02907
Phone (401) 868-0654

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780876800000",
    "number": "1104317007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072423",
            "telephone_number": "401-300-5757",
            "fax_number": "401-300-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE # A",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02907",
            "telephone_number": "401-868-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A",
        "authorized_official_last_name": "DONOYAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "401-300-5757",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "RI",
            "license": "648.01",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "RI",
            "license": "648.01",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.