| NPI | 1174870638 |
|---|---|
| Former Name | AMANDA M LANG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4900-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 888-226) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2017-12-08 |