Provider Demographics
NPI:1710749163
Name:LONG, ALICE HAWLEY (LPC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:HAWLEY
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 COUNTRY CLUB PARK
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-4237
Mailing Address - Country:US
Mailing Address - Phone:205-573-8014
Mailing Address - Fax:
Practice Address - Street 1:2025 SHADY CREST DR UNIT 203
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5417
Practice Address - Country:US
Practice Address - Phone:205-573-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health