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General NPI Number Information
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NPI Number | 1669292033
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Entity Type | Individual
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Provider Name | NANGA CHUNGAG
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 8801 WOODWARD AVE STE 305
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City | DETROIT
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State | MI
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Zip | 48202-2136
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Country | US
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Telephone | 313-473-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 VAN DYKE ST APT 21
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City | DETROIT
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State | MI
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Zip | 48214-3922
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Country | US
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Telephone | 346-702-6795
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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