Provider Demographics
NPI:1245047711
Name:LANG, LETASHA (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:LETASHA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:LETASHA
Other - Middle Name:S
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9677 CAPOT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4176
Mailing Address - Country:US
Mailing Address - Phone:229-869-9140
Mailing Address - Fax:
Practice Address - Street 1:1200 BROOKSTONE CENTRE PKWY STE 226
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2988
Practice Address - Country:US
Practice Address - Phone:706-653-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional