Provider Demographics
NPI:1710255666
Name:LONG, DANIEL GREGORY II (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GREGORY
Last Name:LONG
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 ORCHARD CROSSING
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1728
Mailing Address - Country:US
Mailing Address - Phone:304-685-0559
Mailing Address - Fax:
Practice Address - Street 1:1553 STEWARTSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2947
Practice Address - Country:US
Practice Address - Phone:304-284-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical