Provider Demographics
NPI:1609118314
Name:LANGLEY, REGINA L (CAS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 CANYON OAK DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0729
Mailing Address - Country:US
Mailing Address - Phone:916-266-3415
Mailing Address - Fax:
Practice Address - Street 1:8333 CANYON OAK DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0729
Practice Address - Country:US
Practice Address - Phone:916-266-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-095426101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)