Provider Demographics
NPI:1114253176
Name:LONGO, ROBERT EARL (MRC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:LONGO
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-7854
Mailing Address - Country:US
Mailing Address - Phone:336-406-3006
Mailing Address - Fax:
Practice Address - Street 1:214 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-7854
Practice Address - Country:US
Practice Address - Phone:336-406-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC #6484101YP2500X
ORLPC #C0695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional