Provider Demographics
NPI:1124212964
Name:LANG, JEFFREY JOHN (MS, LCADC, CPRP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOHN
Last Name:LANG
Suffix:
Gender:M
Credentials:MS, LCADC, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1228
Mailing Address - Country:US
Mailing Address - Phone:609-980-3514
Mailing Address - Fax:
Practice Address - Street 1:452 WILSON AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-1228
Practice Address - Country:US
Practice Address - Phone:609-980-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00013700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)