Provider Demographics
NPI:1578996120
Name:VANG, PAJ TSHIAB (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAJ TSHIAB
Middle Name:
Last Name:VANG
Suffix:
Gender:F
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:PO BOX 16262
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93755-6262
Mailing Address - Country:US
Mailing Address - Phone:559-346-9749
Mailing Address - Fax:
Practice Address - Street 1:1350 M ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1808
Practice Address - Country:US
Practice Address - Phone:559-457-3340
Practice Address - Fax:559-457-3373
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933511041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker