Provider Demographics
NPI:1003894254
Name:LANG, CARLA (MDIV, MA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 PASTEUR DR
Mailing Address - Street 2:SUITE 612
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1149
Mailing Address - Country:US
Mailing Address - Phone:336-316-0716
Mailing Address - Fax:336-547-9061
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-316-0716
Practice Address - Fax:336-547-9061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCFBPPC27101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral