Provider Demographics
NPI:1649719667
Name:LONGWORTH, BRITTANY LYN (LAC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYN
Last Name:LONGWORTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LYN
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETTERTON
Mailing Address - State:MD
Mailing Address - Zip Code:21610-9722
Mailing Address - Country:US
Mailing Address - Phone:410-778-2165
Mailing Address - Fax:
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETTERTON
Practice Address - State:MD
Practice Address - Zip Code:21610-9722
Practice Address - Country:US
Practice Address - Phone:410-778-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist