Provider Demographics
NPI:1598063026
Name:XIONG, PHIA TONY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PHIA
Middle Name:TONY
Last Name:XIONG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MAPLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5504
Mailing Address - Country:US
Mailing Address - Phone:651-260-8707
Mailing Address - Fax:651-330-4077
Practice Address - Street 1:366 MAPLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5504
Practice Address - Country:US
Practice Address - Phone:651-260-8707
Practice Address - Fax:651-330-4077
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN178771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical