Provider Demographics
NPI:1932978236
Name:JENG, THONG DANIEL
Entity Type:Individual
Prefix:
First Name:THONG
Middle Name:DANIEL
Last Name:JENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:THONG
Other - Last Name:JENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:111 KENWICK LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4406
Mailing Address - Country:US
Mailing Address - Phone:678-773-0578
Mailing Address - Fax:
Practice Address - Street 1:111 KENWICK LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-4406
Practice Address - Country:US
Practice Address - Phone:678-773-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional