Provider Demographics
NPI:1659943793
Name:CHUNG, ALANNAH LEIGH (CADC)
Entity Type:Individual
Prefix:MRS
First Name:ALANNAH
Middle Name:LEIGH
Last Name:CHUNG
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7669
Mailing Address - Country:US
Mailing Address - Phone:702-478-4046
Mailing Address - Fax:
Practice Address - Street 1:5524 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7669
Practice Address - Country:US
Practice Address - Phone:702-478-4046
Practice Address - Fax:702-924-0630
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06697-I101YA0400X
NV07275-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)