Provider Demographics
NPI:1346975919
Name:GONG, WEIJIA (LMHC)
Entity type:Individual
Prefix:
First Name:WEIJIA
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 SANFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2688
Mailing Address - Country:US
Mailing Address - Phone:917-502-6597
Mailing Address - Fax:
Practice Address - Street 1:14015 SANFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2688
Practice Address - Country:US
Practice Address - Phone:917-502-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014920101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health