Provider Demographics
NPI:1710367826
Name:LONG, SUSAN (BSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 E JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4597
Mailing Address - Country:US
Mailing Address - Phone:931-548-9410
Mailing Address - Fax:
Practice Address - Street 1:230 E JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4597
Practice Address - Country:US
Practice Address - Phone:931-548-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical