Provider Demographics
NPI:1841221157
Name:LONG, JUDITH ROGERS (MA, LPC/I)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ROGERS
Last Name:LONG
Suffix:
Gender:F
Credentials:MA, LPC/I
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15 WOODPINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2921
Mailing Address - Country:US
Mailing Address - Phone:803-732-5572
Mailing Address - Fax:508-448-6585
Practice Address - Street 1:1903 GADSDEN ST STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2352
Practice Address - Country:US
Practice Address - Phone:803-254-9767
Practice Address - Fax:803-254-9740
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional