Provider Demographics
NPI:1275802654
Name:LANG, NICHOLE J
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:J
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PLEASANT ST.
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02719-2505
Mailing Address - Country:US
Mailing Address - Phone:508-558-4305
Mailing Address - Fax:
Practice Address - Street 1:5121 MARYLAND WAY STE 300
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7516
Practice Address - Country:US
Practice Address - Phone:855-246-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91658207P00000X
TN63754207P00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst