Provider Demographics
NPI:1225490436
Name:LONG, SAMINA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ABRAMS RD STE 325
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5579
Mailing Address - Country:US
Mailing Address - Phone:832-292-8255
Mailing Address - Fax:
Practice Address - Street 1:1221 ABRAMS RD STE 325
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5579
Practice Address - Country:US
Practice Address - Phone:832-292-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX72046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist