Provider Demographics
NPI:1194927137
Name:LANGLEY, EDITH ELEANOR (MA,LMFT)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:ELEANOR
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 PARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3278
Mailing Address - Country:US
Mailing Address - Phone:704-527-0760
Mailing Address - Fax:704-527-0887
Practice Address - Street 1:4726 PARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3278
Practice Address - Country:US
Practice Address - Phone:704-527-0760
Practice Address - Fax:704-527-0887
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMFT 0589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135F1OtherBCBSNC PROVIDER ID