Provider Demographics
NPI:1225483134
Name:LANGSTON, CANDACE ERIN (RCEP)
Entity Type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:ERIN
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHARMANT RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2131
Mailing Address - Country:US
Mailing Address - Phone:910-987-3081
Mailing Address - Fax:910-671-1439
Practice Address - Street 1:4895 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2162
Practice Address - Country:US
Practice Address - Phone:910-987-3081
Practice Address - Fax:910-671-1439
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC802703572224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist