Provider Demographics
NPI:1164582698
Name:LANG, MARCIA A (PSYD LCSWC)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:PSYD LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:ASAP
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5800
Mailing Address - Country:US
Mailing Address - Phone:301-677-8895
Mailing Address - Fax:301-677-8957
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:ASAP
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5800
Practice Address - Country:US
Practice Address - Phone:301-677-8895
Practice Address - Fax:301-677-8957
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002833103T00000X
DCLC303025103T00000X
MD08148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist