Provider Demographics
NPI:1497246490
Name:WANG, XIN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:XIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 JACKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1123
Mailing Address - Country:US
Mailing Address - Phone:832-298-2656
Mailing Address - Fax:
Practice Address - Street 1:6910 BELLAIRE BLVD
Practice Address - Street 2:STE 9
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3546
Practice Address - Country:US
Practice Address - Phone:832-298-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty