Provider Demographics
NPI:1356416895
Name:NGUYEN, CHIENTHANG THANH (LPCC, CADC-II)
Entity type:Individual
Prefix:MR
First Name:CHIENTHANG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LPCC, CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2394
Mailing Address - Country:US
Mailing Address - Phone:619-233-3432
Mailing Address - Fax:619-233-7022
Practice Address - Street 1:1963 FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7609
Practice Address - Country:US
Practice Address - Phone:619-233-3432
Practice Address - Fax:619-233-7022
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health