Provider Demographics
NPI:1912245879
Name:LANGE, ANNEMARIE KILLIAN (LPC)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:KILLIAN
Last Name:LANGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 W PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2546
Mailing Address - Country:US
Mailing Address - Phone:484-678-7565
Mailing Address - Fax:
Practice Address - Street 1:610 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1663
Practice Address - Country:US
Practice Address - Phone:484-678-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health