Provider Demographics
NPI:1174824098
Name:LONG, SARAH MICHELLE (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MICHELLE
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:202 S RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3739
Mailing Address - Country:US
Mailing Address - Phone:304-637-1002
Mailing Address - Fax:304-637-1120
Practice Address - Street 1:202 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3739
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:304-637-1120
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker