Provider Demographics
NPI:1861560732
Name:DE LANGE-HANSEN, DENISE NINA
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:NINA
Last Name:DE LANGE-HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:NINA
Other - Last Name:DE LANGE-HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:LOTUS
Mailing Address - State:CA
Mailing Address - Zip Code:95651-0699
Mailing Address - Country:US
Mailing Address - Phone:530-642-0843
Mailing Address - Fax:530-642-0843
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9109
Practice Address - Country:US
Practice Address - Phone:530-642-0843
Practice Address - Fax:530-642-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS4252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health