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General NPI Number Information
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NPI Number | 1275043721
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Entity Type | Individual
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Provider Name | GEORGETTA LYNN LANGLEY CADC, ICADC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 7400 FOUNTAINBLEAU RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-8473
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Country | US
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Telephone | 251-377-3979
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Fax |
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Provider Business Mailing Address
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Address Line | 12506 FORTS LAKE RD
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City | MOSS POINT
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State | MS
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Zip | 39562-6510
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Country | US
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Telephone | 251-377-3979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | AD10-014L
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | AD10-014L
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | AD10-014L
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AD10-014L
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License Number State | MS
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