Healthcare Provider Details

I. General information

NPI: 1740360882
Provider Name (Legal Business Name): TERESA J KANG LCSW, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 W VAN BUREN ST
PHOENIX AZ
85007-2442
US

IV. Provider business mailing address

1243 W GLENMERE DR
CHANDLER AZ
85224-7546
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax: 602-340-9401
Mailing address:
  • Phone: 480-821-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10592
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: