Provider Demographics
NPI:1659524098
Name:THE LONG CENTER FOR PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:THE LONG CENTER FOR PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:828-524-4110
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28744-2076
Mailing Address - Country:US
Mailing Address - Phone:828-524-4110
Mailing Address - Fax:828-349-8983
Practice Address - Street 1:258 LOPES CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3527
Practice Address - Country:US
Practice Address - Phone:828-524-4110
Practice Address - Fax:828-349-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3238103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006578Medicaid
NC2822967CMedicare PIN