Healthcare Provider Details

I. General information

NPI: 1225765712
Provider Name (Legal Business Name): MICHAELA MARIE LANGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N STE 119
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

PO BOX 980
PRINCE FREDERICK MD
20678-0980
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: