Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1245815646 |
---|---|
Provider Name | Noah Lang |
First Address | Whiting, NJ 08759-3501 |
Second Address | Whiting, NJ 08759-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2021 |
Last Update Date | 17/03/2021 |