Provider Demographics
NPI:1497789796
Name:LANGE, STEPHANIE EMMA (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EMMA
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22550 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1189
Mailing Address - Country:US
Mailing Address - Phone:586-465-8332
Mailing Address - Fax:
Practice Address - Street 1:22550 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1189
Practice Address - Country:US
Practice Address - Phone:586-465-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010708441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical