Provider Demographics
NPI:1831671882
Name:LANGDON, MARIAH KATE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIAH
Middle Name:KATE
Last Name:LANGDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARIAH
Other - Middle Name:KATE
Other - Last Name:LUNSFORD-BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3622 N HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8213
Mailing Address - Country:US
Mailing Address - Phone:606-594-2850
Mailing Address - Fax:
Practice Address - Street 1:8467 N HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-4953
Practice Address - Country:US
Practice Address - Phone:606-658-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY2564391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health