Provider Demographics
NPI:1639189095
Name:LANGSTON, TARA DEBUTTS (LPC, CSAC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:DEBUTTS
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3628
Mailing Address - Country:US
Mailing Address - Phone:540-421-5492
Mailing Address - Fax:540-434-8100
Practice Address - Street 1:356 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3628
Practice Address - Country:US
Practice Address - Phone:540-421-5492
Practice Address - Fax:540-434-8100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA407604Medicare UPIN
VA084380Medicare UPIN
VA173725Medicare UPIN