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General NPI Number Information
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NPI Number | 1346004207
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Entity Type | Individual
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Provider Name | LILAH VANG LADC, BS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 1811 WEIR DR STE 270
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City | WOODBURY
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State | MN
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Zip | 55125-6741
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Country | US
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Telephone | 651-243-6072
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Fax | 651-714-9647
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Provider Business Mailing Address
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Address Line | 5192 360TH ST
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City | NORTH BRANCH
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State | MN
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Zip | 55056-5501
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Country | US
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Telephone | 651-404-0267
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MN
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