Provider Demographics
NPI:1609383959
Name:LANGLEY, THOMAS CARLYLE IV (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CARLYLE
Last Name:LANGLEY
Suffix:IV
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BEACON DR STE I
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7996
Mailing Address - Country:US
Mailing Address - Phone:252-353-1114
Mailing Address - Fax:
Practice Address - Street 1:154 BEACON DR STE I
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7996
Practice Address - Country:US
Practice Address - Phone:252-353-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0128081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical