Healthcare Provider Details

I. General information

NPI: 1275600710
Provider Name (Legal Business Name): GIOIA M. TANGO LMHC, LADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 COURT ST SUITE # 3
PLYMOUTH MA
02360-8721
US

IV. Provider business mailing address

754 LONG POND RD
PLYMOUTH MA
02360-2625
US

V. Phone/Fax

Practice location:
  • Phone: 508-878-7040
  • Fax:
Mailing address:
  • Phone: 508-878-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: