Provider Demographics
NPI:1376896696
Name:LANG, DELIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:L
Last Name:LANG
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 1:182 IVY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1752
Mailing Address - Country:US
Mailing Address - Phone:404-634-3400
Mailing Address - Fax:
Practice Address - Street 1:2440 LAWRENCEVILLE HWY STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3267
Practice Address - Country:US
Practice Address - Phone:404-634-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical