Provider Demographics
NPI:1194959924
Name:LANGSTON, STEPHANIE C (LP, QS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:LP, QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 JAKES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-9655
Mailing Address - Country:US
Mailing Address - Phone:828-200-3679
Mailing Address - Fax:828-832-8013
Practice Address - Street 1:895 STATE FARM RD STE 504
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4689
Practice Address - Country:US
Practice Address - Phone:828-200-3679
Practice Address - Fax:828-832-8013
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059029101YM0800X
NC4843103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health