Provider Demographics
NPI:1558826156
Name:LANGLEY, MELISSA KAY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 PEACHTREE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-8813
Mailing Address - Country:US
Mailing Address - Phone:252-904-2206
Mailing Address - Fax:
Practice Address - Street 1:1371 PEACHTREE HILLS RD
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-8813
Practice Address - Country:US
Practice Address - Phone:252-904-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional