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General NPI Number Information
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NPI Number | 1649519356
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Entity Type | Individual
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Provider Name | SANDI LANGHAM LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 1770 W BERTEAU AVE STE 302A
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City | CHICAGO
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State | IL
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Zip | 60613-1849
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Country | US
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Telephone | 773-720-8367
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Fax |
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Provider Business Mailing Address
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Address Line | 4619 N DOVER ST
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City | CHICAGO
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State | IL
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Zip | 60640-4652
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Country | US
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Telephone | 773-720-8367
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.008077
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License Number State | IL
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