Provider Demographics
NPI:1811660228
Name:HIGBIE-LONG, SUZANNE M (MA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:HIGBIE-LONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 DONALDSON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5198
Mailing Address - Country:US
Mailing Address - Phone:321-202-0467
Mailing Address - Fax:
Practice Address - Street 1:9451 MERRIFIELD ST UNIT A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-3847
Practice Address - Country:US
Practice Address - Phone:407-504-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health