Provider Demographics
NPI:1851502983
Name:LANGE, AMBER (LPC)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAAC
Mailing Address - Street 1:8336 MONROE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9339
Mailing Address - Country:US
Mailing Address - Phone:734-807-0162
Mailing Address - Fax:888-700-7159
Practice Address - Street 1:8336 MONROE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9339
Practice Address - Country:US
Practice Address - Phone:734-807-0162
Practice Address - Fax:888-700-7159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health