Basic Information
| Provider Information | |||||||||
| NPI: | 1124438148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | COUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2167 MONTGOMERY ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959654945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2167 MONTGOMERY ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959654945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387277 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 04/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.