Healthcare Provider Details

I. General information

NPI: 1508055013
Provider Name (Legal Business Name): STEVEN HING WONG LPCC, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2007
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 RENARD PL SE STE 117
ALBUQUERQUE NM
87106-4264
US

IV. Provider business mailing address

424 BRYN MAWR DR SE
ALBUQUERQUE NM
87106-2206
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-5976
  • Fax: 505-256-5171
Mailing address:
  • Phone: 505-401-5976
  • Fax: 505-256-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0108411
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0108421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: