Provider Demographics
NPI:1265779722
Name:LANGSTAFF, CHARISSA (MSW, LISW)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:LANGSTAFF
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 W MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4653
Mailing Address - Country:US
Mailing Address - Phone:419-222-1527
Mailing Address - Fax:419-222-3586
Practice Address - Street 1:658 W MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4653
Practice Address - Country:US
Practice Address - Phone:419-222-1527
Practice Address - Fax:419-222-3586
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 12008471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical