Provider Demographics
NPI:1689843161
Name:FONG, AARON CHRISTOPHER (MA, RC)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:CHRISTOPHER
Last Name:FONG
Suffix:
Gender:M
Credentials:MA, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DEERMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6649
Mailing Address - Country:US
Mailing Address - Phone:907-225-7825
Mailing Address - Fax:907-225-1541
Practice Address - Street 1:1 EASY STREET
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-9800
Practice Address - Country:US
Practice Address - Phone:907-826-3891
Practice Address - Fax:907-826-3892
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053968101YM0800X
WACG60137795101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00053968OtherREGISTERED COUNSELOR
WACG60137795OtherAGENCY AFFILIATED COUNSELOR