Provider Demographics
NPI:1346588027
Name:LANG, ELAINE J (APRN,CNS-BC,CACII)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:J
Last Name:LANG
Suffix:
Gender:F
Credentials:APRN,CNS-BC,CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-3172
Mailing Address - Country:US
Mailing Address - Phone:864-978-8232
Mailing Address - Fax:864-542-2102
Practice Address - Street 1:657 HWY 221 NORTH (WHITNEY RD.)
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:20303
Practice Address - Country:US
Practice Address - Phone:854-978-8232
Practice Address - Fax:864-542-2102
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1209018101YA0400X
SC18414364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1209018OtherCACII