Provider Demographics
NPI:1801148184
Name:LONG, LATRANETTE (LMHC-QS, LPC)
Entity type:Individual
Prefix:
First Name:LATRANETTE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LMHC-QS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 E ADAMO DR UNIT 89472
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-9026
Mailing Address - Country:US
Mailing Address - Phone:813-856-9703
Mailing Address - Fax:
Practice Address - Street 1:1210 MILLENNIUM PKWY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4896
Practice Address - Country:US
Practice Address - Phone:813-856-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health