Provider Demographics
NPI:1346460136
Name:LANGFORD, DEE (EDD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 HERITAGE BUSINESS CT
Mailing Address - Street 2:SUITE 712
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7015
Mailing Address - Country:US
Mailing Address - Phone:423-510-9505
Mailing Address - Fax:423-510-9548
Practice Address - Street 1:735 E 10TH ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2917
Practice Address - Country:US
Practice Address - Phone:423-510-9504
Practice Address - Fax:423-510-9548
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5963792103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733189Medicaid
TN3733189Medicare ID - Type Unspecified