Provider Demographics
NPI:1063442069
Name:LANGSTON, DELORES H (MSW)
Entity type:Individual
Prefix:MS
First Name:DELORES
Middle Name:H
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-0164
Mailing Address - Country:US
Mailing Address - Phone:810-423-4560
Mailing Address - Fax:
Practice Address - Street 1:1433 ELDORADO DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-3221
Practice Address - Country:US
Practice Address - Phone:810-423-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020828571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical