Provider Demographics
NPI:1053636563
Name:LONG, SARAH E (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
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 1:1420 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1519
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-697-1286
Practice Address - Street 1:3375 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2837
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-697-1286
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid