Provider Demographics
NPI:1699408096
Name:LONG, AIMEE (MHRT-CSP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MHRT-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:8 WESLEYAN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-2010
Practice Address - Country:US
Practice Address - Phone:207-473-9285
Practice Address - Fax:207-473-9403
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor