Provider Demographics
NPI:1467294108
Name:LONG, SARAH DEARSTYNE (LCASA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DEARSTYNE
Last Name:LONG
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 ROYAL TERN WAY
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4933
Mailing Address - Country:US
Mailing Address - Phone:252-503-9820
Mailing Address - Fax:
Practice Address - Street 1:1703 ROYAL TERN WAY
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4933
Practice Address - Country:US
Practice Address - Phone:252-503-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)