Provider Demographics
NPI:1790086098
Name:VANG, NENG CHARLES (LSW)
Entity Type:Individual
Prefix:
First Name:NENG
Middle Name:CHARLES
Last Name:VANG
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EMPIRE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1856
Mailing Address - Country:US
Mailing Address - Phone:651-292-9900
Mailing Address - Fax:
Practice Address - Street 1:23 EMPIRE DR STE 125
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1856
Practice Address - Country:US
Practice Address - Phone:651-292-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker