Provider Demographics
NPI:1245695196
Name:LONG, LORI M (LPC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0412
Mailing Address - Country:US
Mailing Address - Phone:276-393-5728
Mailing Address - Fax:276-393-5728
Practice Address - Street 1:350 RUSSELL RD NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2761
Practice Address - Country:US
Practice Address - Phone:276-393-5728
Practice Address - Fax:276-628-1112
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701006000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601094525Medicaid