Healthcare Provider Details

I. General information

NPI: 1174377782
Provider Name (Legal Business Name): VICKIE VUONG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9092 BIOLA LN
GARDEN GROVE CA
92844-2206
US

IV. Provider business mailing address

9092 BIOLA LN
GARDEN GROVE CA
92844-2206
US

V. Phone/Fax

Practice location:
  • Phone: 714-757-6417
  • Fax:
Mailing address:
  • Phone: 714-757-6417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: