Provider Demographics
NPI:1285327171
Name:LANG, BETHANY R (MS NCC NCSC LPC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:R
Last Name:LANG
Suffix:
Gender:F
Credentials:MS NCC NCSC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6454 GRISTMILL SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3723
Mailing Address - Country:US
Mailing Address - Phone:610-212-9312
Mailing Address - Fax:
Practice Address - Street 1:6454 GRISTMILL SQUARE LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3723
Practice Address - Country:US
Practice Address - Phone:610-212-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional