Provider Demographics
NPI:1790724037
Name:ZACHARY-LANG, MARY I (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:ZACHARY-LANG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 ALEWIVE RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6010
Mailing Address - Country:US
Mailing Address - Phone:207-985-4704
Mailing Address - Fax:207-985-4704
Practice Address - Street 1:895 ALEWIVE RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6010
Practice Address - Country:US
Practice Address - Phone:207-985-4704
Practice Address - Fax:207-985-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health