Doctor Name: | DR. SIDNEY WHITLEY LANGSTON |
NPI Number: | 1104046416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D., D.MIN., R.N. |
License Number: | 076547 |
Business Practice Address: | 116 S. Providence St. Waxhaw, NC - 281731044 |
Business Phone Number: | 7048434818 |
Business Fax Number: | 7048435111 |
Mailing Address: | Po Box 327, 116 S. Providence St. WAXHAW |
State: | NC |
Postal Code: | 281731044 |
Phone Number: | 7048434818 |
Fax Number: | 7048435111 |
NPI Enumeration Date: | 04/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 076547 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |