Provider Demographics
NPI:1740425875
Name:LONG, CYNTHIA MICHELLE (BA, QP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:BA, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 RUNNING DEER DR NW
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8039
Mailing Address - Country:US
Mailing Address - Phone:828-318-2971
Mailing Address - Fax:
Practice Address - Street 1:101 GOVERNMENT AVE SW
Practice Address - Street 2:SUITE 300
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2936
Practice Address - Country:US
Practice Address - Phone:828-315-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health