Provider Demographics
NPI:1942763982
Name:STEPHANIE LANGSTON PH.D., PLLC
Entity Type:Organization
Organization Name:STEPHANIE LANGSTON PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, QUALIFIED SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LP, QS
Authorized Official - Phone:828-200-3679
Mailing Address - Street 1:562 JAKES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-9655
Mailing Address - Country:US
Mailing Address - Phone:828-200-3679
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD STE 504
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4689
Practice Address - Country:US
Practice Address - Phone:828-200-3679
Practice Address - Fax:828-832-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)