Provider Demographics
NPI:1538741020
Name:ONG, JACQUELINE (LADC, LADC-S)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:LADC, LADC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 TOPSY LN STE 306
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-8407
Mailing Address - Country:US
Mailing Address - Phone:775-721-0921
Mailing Address - Fax:
Practice Address - Street 1:2560 BUSINESS PKWY
Practice Address - Street 2:STE A
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8961
Practice Address - Country:US
Practice Address - Phone:775-721-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NV06789-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator