Provider Demographics
NPI:1811558885
Name:LONG, REBECCA DIANNE (MC, NCC, LCAS, LCMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANNE
Last Name:LONG
Suffix:
Gender:F
Credentials:MC, NCC, LCAS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5809
Mailing Address - Country:US
Mailing Address - Phone:828-406-1654
Mailing Address - Fax:
Practice Address - Street 1:501 OAK ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5809
Practice Address - Country:US
Practice Address - Phone:828-406-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC347869101Y00000X
NC21331101YA0400X
NC11404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)