Provider Demographics
NPI:1417595422
Name:VANG, KAEO (LCSW)
Entity Type:Individual
Prefix:
First Name:KAEO
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 G ST OFC 539
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1800
Mailing Address - Country:US
Mailing Address - Phone:916-341-3036
Mailing Address - Fax:
Practice Address - Street 1:906 G ST OFC 539
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1800
Practice Address - Country:US
Practice Address - Phone:916-341-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health