Provider Demographics
NPI:1053086843
Name:RODNEY LONG JR. COUNSELING, LLC.
Entity Type:Organization
Organization Name:RODNEY LONG JR. COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:330-958-4038
Mailing Address - Street 1:162 NORTHEAST AVE
Mailing Address - Street 2:PO BOX 342
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:330-958-4038
Mailing Address - Fax:
Practice Address - Street 1:10 W STREETSBORO ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2850
Practice Address - Country:US
Practice Address - Phone:330-510-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274713Medicaid
OH14558956OtherCAQH