MEDICARE: MS. GEORGETTA LYNN LANGLEY CADC, ICADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	AD10-014L	MS
2	251B00000X	Case Management Agency	AD10-014L	MS
3	251S00000X	Community/Behavioral Health Agency	AD10-014L	MS
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	AD10-014L	MS

General Provider Information

NPI Number	:	1275043721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGETTA LYNN LANGLEY CADC, ICADC

Provider Business Mailing Address
First Line	:	12506 FORTS LAKE RD
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-6510
Country	:	US
Telephone Number	:	251-377-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 FOUNTAINBLEAU RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8473
Country	:	US
Telephone Number	:	251-377-3979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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