Provider Demographics
NPI:1790395234
Name:WANG, PENG (PHD IN COUNSELING)
Entity Type:Individual
Prefix:MS
First Name:PENG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 MOUNT AIREY LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1550
Mailing Address - Country:US
Mailing Address - Phone:985-788-4364
Mailing Address - Fax:
Practice Address - Street 1:25 ELM PL FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5355
Practice Address - Country:US
Practice Address - Phone:985-788-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2993834101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool