Provider Demographics
NPI:1245319672
Name:LONG, LORNA A (MS,LCSW)
Entity type:Individual
Prefix:MS
First Name:LORNA
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:MS,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 12TH ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3279
Mailing Address - Country:US
Mailing Address - Phone:304-232-4688
Mailing Address - Fax:304-232-4682
Practice Address - Street 1:40 12TH ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3279
Practice Address - Country:US
Practice Address - Phone:304-232-4688
Practice Address - Fax:304-232-4682
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCPOO812202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker