Provider Demographics
NPI:1093022832
Name:LONG, CHRISTIANE C (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:C
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:CHRISTIANE
Other - Middle Name:
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 E. CENTER ST. STE 200-C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:501-492-9216
Mailing Address - Fax:
Practice Address - Street 1:31 E. CENTER ST. STE 200-C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:501-492-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3934-M104100000X
MO20240051191041C0700X
AR6934C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker