Healthcare Provider Details

I. General information

NPI: 1083795520
Provider Name (Legal Business Name): JANICE M DELANGE PH.D. MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE SUITE 260
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

1514 WEALTHY ST. SE SUITE 260
GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-3008
  • Fax: 616-451-3070
Mailing address:
  • Phone: 616-957-8159
  • Fax: 616-451-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801066023
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00006285
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: