Provider Demographics
NPI:1205428059
Name:TANG, ABIGAIL VENO (LPCC)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:VENO
Last Name:TANG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 OAKWAY
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3275
Mailing Address - Country:US
Mailing Address - Phone:952-451-4760
Mailing Address - Fax:
Practice Address - Street 1:1339 PELICAN LN
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2726
Practice Address - Country:US
Practice Address - Phone:218-844-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health