Provider Demographics
NPI:1629422233
Name:LONG, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
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 1:2214 LANDOVER PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2116
Mailing Address - Country:US
Mailing Address - Phone:434-948-4860
Mailing Address - Fax:434-847-2795
Practice Address - Street 1:620 COURT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1312
Practice Address - Country:US
Practice Address - Phone:434-485-8865
Practice Address - Fax:434-485-8877
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist