Provider Demographics
NPI:1821235243
Name:LANG, TINGLE M (LSW)
Entity Type:Individual
Prefix:
First Name:TINGLE
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 MOLER AVE
Mailing Address - Street 2:APT A
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2035
Mailing Address - Country:US
Mailing Address - Phone:304-685-5008
Mailing Address - Fax:
Practice Address - Street 1:1351 MOLER AVE
Practice Address - Street 2:APT A
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-2035
Practice Address - Country:US
Practice Address - Phone:304-685-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-8011201041C0700X
WVBP009432911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical