Healthcare Provider Details

I. General information

NPI: 1215708219
Provider Name (Legal Business Name): TERRY VANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 1ST ST
EUREKA CA
95501-0840
US

IV. Provider business mailing address

2107 1ST ST
EUREKA CA
95501-0840
US

V. Phone/Fax

Practice location:
  • Phone: 707-273-6395
  • Fax:
Mailing address:
  • Phone: 707-273-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: