Provider Demographics
NPI:1245564350
Name:LONG, JANINE K (MS; LPC)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:K
Last Name:LONG
Suffix:
Gender:F
Credentials:MS; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 NE 166TH ST APT 213
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3870
Mailing Address - Country:US
Mailing Address - Phone:717-808-7716
Mailing Address - Fax:
Practice Address - Street 1:3275 NW 99TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4024
Practice Address - Country:US
Practice Address - Phone:954-357-7961
Practice Address - Fax:717-390-1812
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006455101YP2500X
FLMH14993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional