Provider Demographics
NPI:1275304271
Name:LONG, ALEXIS NICOLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4524
Mailing Address - Country:US
Mailing Address - Phone:504-373-5901
Mailing Address - Fax:504-373-5922
Practice Address - Street 1:101 OLD HICKORY ST
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4524
Practice Address - Country:US
Practice Address - Phone:504-373-5901
Practice Address - Fax:504-373-5922
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health