Basic Information
| Provider Information | |||||||||
| NPI: | 1174981682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC-I | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LANG | ||||||||
| OtherFirstName: | CHARLOTTE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC-I | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2150 GENERAL PERSHING ST | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704485125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856359225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 54002 HIGHWAY 1062 | ||||||||
| Address2: | |||||||||
| City: | LORANGER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704463538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256835292 | ||||||||
| FaxNumber: | 2256831310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6639 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.