Provider Demographics
NPI:1417710989
Name:DUONG, PHAM NHA UYEN (MA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:PHAM NHA UYEN
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11903 AUBREYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1033
Mailing Address - Country:US
Mailing Address - Phone:803-908-8302
Mailing Address - Fax:
Practice Address - Street 1:17714 KINGS POINT DR STE A&B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6928
Practice Address - Country:US
Practice Address - Phone:704-997-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health