Provider Demographics
NPI:1225231160
Name:DELANGE, CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:DELANGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3530
Mailing Address - Country:US
Mailing Address - Phone:248-613-0091
Mailing Address - Fax:
Practice Address - Street 1:1700 W BIG BEAVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3530
Practice Address - Country:US
Practice Address - Phone:248-613-0091
Practice Address - Fax:248-792-6987
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical