Provider Demographics
NPI:1003142142
Name:LONG, ERIN MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 TOWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2631
Mailing Address - Country:US
Mailing Address - Phone:330-608-4517
Mailing Address - Fax:
Practice Address - Street 1:555 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-0920
Practice Address - Country:US
Practice Address - Phone:415-403-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-25
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700023101YP2500X
OHC 0700023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional