Basic Information
| Provider Information | |||||||||
| NPI: | 1114342425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4111 W GROVE CT | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932914162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599671000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 942 S SANTA FE ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932922912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596364000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2014 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT97350 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.