Provider Demographics
NPI:1740554997
Name:LONG, KATHERINE D (MS, LCMHC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:D
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 NORTH ROGERS LANE
Mailing Address - Street 2:STE 121, PMB 1035
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4099
Mailing Address - Country:US
Mailing Address - Phone:844-855-6650
Mailing Address - Fax:
Practice Address - Street 1:1030 NORTH ROGERS LANE
Practice Address - Street 2:STE 121, PMB 1035
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4099
Practice Address - Country:US
Practice Address - Phone:844-855-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health