Provider Demographics
NPI:1902965981
Name:WONG, GRACE L
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:L
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 MOWRY AVE
Mailing Address - Street 2:APT 113
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1117
Mailing Address - Country:US
Mailing Address - Phone:510-792-4064
Mailing Address - Fax:
Practice Address - Street 1:1385 MISSION ST
Practice Address - Street 2:AARTI SHP
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2623
Practice Address - Country:US
Practice Address - Phone:415-775-9361
Practice Address - Fax:415-775-4507
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health