Provider Demographics
NPI:1831914373
Name:WONG, ZIDONIA M (LMSW, CSWI)
Entity type:Individual
Prefix:MISS
First Name:ZIDONIA
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:LMSW, CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335243
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89033-5243
Mailing Address - Country:US
Mailing Address - Phone:702-608-5664
Mailing Address - Fax:
Practice Address - Street 1:570 W CHEYENNE AVE STE 190
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3983
Practice Address - Country:US
Practice Address - Phone:702-350-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11504-M104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker