MEDICARE: LANGLEY HEALTHCARE GROUP

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1992667620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGLEY HEALTHCARE GROUP

Provider Business Mailing Address
First Line	:	2560 HUNTINGTON AVE STE 402
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-1449
Country	:	US
Telephone Number	:	301-523-1302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 HUNTINGTON AVE STE 402
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-1449
Country	:	US
Telephone Number	:	301-523-1302
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	COURTNEY WANDELOSKI
Credential	:
Telephone Number	:	410-353-8724

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “LANGLEY HEALTHCARE GROUP ” Practice Location

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