Individual
MAI KER VANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-0102
Mailing address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-0102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PT40697
CA
167G00000X
Licensed Psychiatric Technician
Primary
PT40697
CA
Other
Enumeration date
02/05/2018
Last updated
10/26/2023
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