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General NPI Number Information
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NPI Number | 1588416002
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Entity Type | Individual
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Provider Name | TAMARA BATRICE CLESTINE VANG CRADC, MARS, LAC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 9824 CHERRY ST APT 5
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City | KANSAS CITY
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State | MO
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Zip | 64131-4129
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Country | US
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Telephone | 816-419-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 10808 CLEVELAND AVE
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City | KANSAS CITY
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State | KS
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Zip | 66109-3659
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Country | US
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Telephone | 816-739-9313
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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 | 01954
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15342
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15228
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License Number State | MO
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