Provider Demographics
NPI:1396387528
Name:LONG, TERRI (LCPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6004
Mailing Address - Country:US
Mailing Address - Phone:443-929-6393
Mailing Address - Fax:
Practice Address - Street 1:1208 E CHURCHVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3485
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:443-640-4358
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor