Healthcare Provider Details

I. General information

NPI: 1386111284
Provider Name (Legal Business Name): TOMMY HOANG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REGENT ST
LIVINGSTON NJ
07039-1675
US

IV. Provider business mailing address

117 WESMONT DR
WOOD RIDGE NJ
07075-2145
US

V. Phone/Fax

Practice location:
  • Phone: 973-994-1011
  • Fax:
Mailing address:
  • Phone: 973-568-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00643500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: