Provider Demographics
NPI:1871951079
Name:LANGSTON, SHAWNE
Entity type:Individual
Prefix:
First Name:SHAWNE
Middle Name:
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 E BROOKSTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-4603
Mailing Address - Country:US
Mailing Address - Phone:225-936-8773
Mailing Address - Fax:225-927-0771
Practice Address - Street 1:4255 E BROOKSTOWN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4603
Practice Address - Country:US
Practice Address - Phone:225-936-8773
Practice Address - Fax:225-927-0770
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA146101YA0400X
LA3791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)