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General NPI Number Information
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NPI Number | 1104411784
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Entity Type | Individual
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Provider Name | MICHELLE WONG LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 777 S ALAMEDA ST FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90021-1656
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Country | US
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Telephone | 213-289-3578
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Fax | 213-357-3667
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Provider Business Mailing Address
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Address Line | 14377 TELLURIDE DR
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5421
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Country | US
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Telephone | 626-384-7855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 124666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 124666
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License Number State | CA
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