Provider Demographics
NPI:1437791142
Name:WANG, VICKI (MA, LAC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1052
Mailing Address - Country:US
Mailing Address - Phone:732-289-5125
Mailing Address - Fax:
Practice Address - Street 1:720 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4406
Practice Address - Country:US
Practice Address - Phone:609-664-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00449900101YM0800X
NJ1095237101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health