Provider Demographics
NPI:1417796830
Name:TANG, DICKSON (MA)
Entity type:Individual
Prefix:
First Name:DICKSON
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 19TH ST NW APT 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1466
Mailing Address - Country:US
Mailing Address - Phone:202-281-8209
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1739
Practice Address - Country:US
Practice Address - Phone:202-952-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health