Provider Demographics
NPI:1851665129
Name:LONG, NINA (MS, CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SEABREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-6421
Mailing Address - Country:US
Mailing Address - Phone:561-847-0220
Mailing Address - Fax:
Practice Address - Street 1:214 SEABREEZE CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6421
Practice Address - Country:US
Practice Address - Phone:561-847-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4418101YA0400X
FL120999101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)