Basic Information
| Provider Information | |||||||||
| NPI: | 1164582698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD LCSWC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2480 LLEWELLYN AVE | ||||||||
| Address2: | ASAP | ||||||||
| City: | FORT GEORGE G MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207555800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016778895 | ||||||||
| FaxNumber: | 3016778957 | ||||||||
| Practice Location | |||||||||
| Address1: | 2480 LLEWELLYN AVE | ||||||||
| Address2: | ASAP | ||||||||
| City: | FORT GEORGE G MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207555800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016778895 | ||||||||
| FaxNumber: | 3016778957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 0904002833 | VA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | LC303025 | DC | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 08148 | MD | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.