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General NPI Number Information
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NPI Number | 1699445106
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Entity Type | Individual
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Provider Name | SHANNON CHIA NGONG
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 500 WESTOVER DR # 13619
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City | SANFORD
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State | NC
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Zip | 27330-8941
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 16808 CAPERI DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-6224
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Country | US
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Telephone |
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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 | 113461
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License Number State | TX
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