Provider Demographics
NPI:1023785219
Name:LANGE, KIRSTEN ALLISON (CATC III)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ALLISON
Last Name:LANGE
Suffix:
Gender:F
Credentials:CATC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PLAYA CIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1621
Mailing Address - Country:US
Mailing Address - Phone:970-209-7286
Mailing Address - Fax:
Practice Address - Street 1:2121 HERNDON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6302
Practice Address - Country:US
Practice Address - Phone:970-209-7286
Practice Address - Fax:559-746-7202
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114692910OtherTRUE NORTH DETOX, LLC
CA1144996158OtherFIRST STEPS RECOVERY ADDICTION COUNSELING AND FAMILY SERVICES PROG CORP