Provider Demographics
NPI:1568746071
Name:LANG, SUSAN THERESA (LVN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:THERESA
Last Name:LANG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11249 OAK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9399
Mailing Address - Country:US
Mailing Address - Phone:530-749-8640
Mailing Address - Fax:530-749-8684
Practice Address - Street 1:1496 N BEALE RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6205
Practice Address - Country:US
Practice Address - Phone:530-749-8640
Practice Address - Fax:530-749-8646
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN141243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)