Provider Demographics
NPI:1780944850
Name:LANGE WELLNESS, PLLC
Entity type:Organization
Organization Name:LANGE WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:910-515-7021
Mailing Address - Street 1:206 CAUSEWAY DR #358
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480
Mailing Address - Country:US
Mailing Address - Phone:910-232-6523
Mailing Address - Fax:
Practice Address - Street 1:1508 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5730
Practice Address - Country:US
Practice Address - Phone:910-232-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102573Medicaid