Healthcare Provider Details

I. General information

NPI: 1417796830
Provider Name (Legal Business Name): DICKSON TANG MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 201
WASHINGTON DC
20036-1739
US

IV. Provider business mailing address

2314 19TH ST NW APT 11
WASHINGTON DC
20009-1466
US

V. Phone/Fax

Practice location:
  • Phone: 202-952-7105
  • Fax:
Mailing address:
  • Phone: 202-281-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: