Provider Demographics
NPI:1285827568
Name:DEGUIA, THAO THANH NGUYEN (LCSW)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:THANH NGUYEN
Last Name:DEGUIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ST PAUL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5660
Mailing Address - Country:US
Mailing Address - Phone:213-249-9388
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:600 ST PAUL AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5660
Practice Address - Country:US
Practice Address - Phone:213-249-9388
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW767201041C0700X
CAASW61874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical