Provider Demographics
NPI:1013372275
Name:LONG, TEKIA BILLETTE (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:TEKIA
Middle Name:BILLETTE
Last Name:LONG
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 PEACHTREE ST NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3041
Mailing Address - Country:US
Mailing Address - Phone:225-341-0855
Mailing Address - Fax:404-393-5074
Practice Address - Street 1:1401 PEACHTREE ST NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3041
Practice Address - Country:US
Practice Address - Phone:225-341-0855
Practice Address - Fax:404-393-5074
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional