Provider Demographics
NPI:1982926358
Name:HOLLOWAY, LANGDON L (LCSW, CASAC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:LANGDON
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LCSW, CASAC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2428
Mailing Address - Country:US
Mailing Address - Phone:718-951-9009
Mailing Address - Fax:718-951-9719
Practice Address - Street 1:1463 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2428
Practice Address - Country:US
Practice Address - Phone:718-951-9009
Practice Address - Fax:718-951-9719
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22164101YA0400X
NY076625-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)