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General NPI Number Information
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NPI Number | 1538741020
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Entity Type | Individual
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Provider Name | JACQUELINE ONG LADC, LADC-S
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 2560 BUSINESS PKWY STE A
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City | MINDEN
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State | NV
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Zip | 89423-8961
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Country | US
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Telephone | 775-721-0921
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Fax |
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Provider Business Mailing Address
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Address Line | 963 TOPSY LN STE 306
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City | CARSON CITY
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State | NV
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Zip | 89705-8407
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Country | US
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Telephone | 775-721-0921
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06789-L
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License Number State | NV
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