Provider Demographics
NPI:1245564822
Name:LONG, JAMES JR (MED, NCC, LPC, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LONG
Suffix:JR
Gender:M
Credentials:MED, NCC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 BROOKS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3424
Mailing Address - Country:US
Mailing Address - Phone:202-558-8536
Mailing Address - Fax:301-925-2317
Practice Address - Street 1:4409 FORBES BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4373
Practice Address - Country:US
Practice Address - Phone:301-648-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional