Provider Demographics
NPI:1124042536
Name:VANG, LA (LCSW)
Entity Type:Individual
Prefix:
First Name:LA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LA
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-0009
Mailing Address - Country:US
Mailing Address - Phone:910-673-9111
Mailing Address - Fax:910-673-6202
Practice Address - Street 1:110 W WALKER AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6760
Practice Address - Country:US
Practice Address - Phone:336-633-7043
Practice Address - Fax:336-625-4969
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106675Medicaid
NC2851897Medicare PIN