Provider Demographics
NPI:1699294702
Name:LANGFORD, WARREN SR (MABC, MAHSC, LCADC)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:LANGFORD
Suffix:SR
Gender:M
Credentials:MABC, MAHSC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 ROUNDTOP RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8289
Mailing Address - Country:US
Mailing Address - Phone:174-080-4158
Mailing Address - Fax:
Practice Address - Street 1:1165 ROUNDTOP RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8289
Practice Address - Country:US
Practice Address - Phone:740-804-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X
KY261433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker