Provider Demographics
NPI:1609857887
Name:LONG-INNES, DANA B (LPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:B
Last Name:LONG-INNES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2506
Mailing Address - Country:US
Mailing Address - Phone:615-327-3473
Mailing Address - Fax:615-327-0215
Practice Address - Street 1:118 29TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2506
Practice Address - Country:US
Practice Address - Phone:615-327-3473
Practice Address - Fax:615-327-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPC1430OtherLICENSE