Provider Demographics
NPI:1366627317
Name:WANG, GRACE TOO SHAO (LMHC, CASACT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:TOO SHAO
Last Name:WANG
Suffix:
Gender:F
Credentials:LMHC, CASACT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:TOO
Other - Last Name:SHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18843 120TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3616
Mailing Address - Country:US
Mailing Address - Phone:347-649-5212
Mailing Address - Fax:
Practice Address - Street 1:18843 120TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:347-649-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004478-1101YM0800X
NY29886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)