Basic Information
| Provider Information | |||||||||
| NPI: | 1356416895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | CHIENTHANG | ||||||||
| MiddleName: | THANH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPCC, CADC-II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1963 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192333432 | ||||||||
| FaxNumber: | 6192337022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1963 FOURTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921017609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192333432 | ||||||||
| FaxNumber: | 6192337022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 05/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 1047 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.