Provider Demographics
NPI:1265448146
Name:LONG, LORETTE MARIE (PCC-S LICDC BCPC)
Entity Type:Individual
Prefix:MRS
First Name:LORETTE
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:PCC-S LICDC BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STOW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2560
Mailing Address - Country:US
Mailing Address - Phone:234-334-3132
Mailing Address - Fax:234-706-6781
Practice Address - Street 1:111 STOW AVE STE 100
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2560
Practice Address - Country:US
Practice Address - Phone:234-334-3132
Practice Address - Fax:234-706-6781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA11029101YM0800X
OHE3139101YP2500X
OH965570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional