Provider Demographics
NPI:1598145765
Name:LANGE, KATHLEENE (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEENE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 SOUTHWOOD CIR SW
Mailing Address - Street 2:APT 1117
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8817
Mailing Address - Country:US
Mailing Address - Phone:607-280-9616
Mailing Address - Fax:
Practice Address - Street 1:9876 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3970
Practice Address - Country:US
Practice Address - Phone:770-516-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor