Provider Demographics
NPI:1164601993
Name:VANG, SONG (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:SONG
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2165
Mailing Address - Country:US
Mailing Address - Phone:916-296-1680
Mailing Address - Fax:916-734-4150
Practice Address - Street 1:3671 BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2165
Practice Address - Country:US
Practice Address - Phone:916-296-1680
Practice Address - Fax:916-734-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist