Provider Demographics
NPI:1346662525
Name:WONG, CONSTANCE REBECCA (MA, NCC, LPCA)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:REBECCA
Last Name:WONG
Suffix:
Gender:F
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 J N PEASE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4540
Mailing Address - Country:US
Mailing Address - Phone:704-565-9664
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4540
Practice Address - Country:US
Practice Address - Phone:704-565-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional