Provider Demographics
NPI:1932475779
Name:LONG, BRIAN LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEE
Last Name:LONG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:562 LAKELAND PLZ # 326
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2783
Mailing Address - Country:US
Mailing Address - Phone:404-644-8967
Mailing Address - Fax:678-261-1622
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:4245
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:404-644-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006744101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor