Provider Demographics
NPI:1538172952
Name:WANG, LANI PORTER (LMSW)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:PORTER
Last Name:WANG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E LIBERTY ST STE 310
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2181
Mailing Address - Country:US
Mailing Address - Phone:734-864-2876
Mailing Address - Fax:
Practice Address - Street 1:1465 KING GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6923
Practice Address - Country:US
Practice Address - Phone:734-864-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010853861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical