Provider Demographics
NPI:1811903669
Name:LONGWORTH, ROSE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:LONGWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:LONGWORTH
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1241 NORTH MAIN STREET
Mailing Address - Street 2:HARRISONBURG ROCKINGHAM COMMUNITY SERVICES BOARD
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-0000
Mailing Address - Country:US
Mailing Address - Phone:540-434-1941
Mailing Address - Fax:540-434-1791
Practice Address - Street 1:1241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-4632
Practice Address - Country:US
Practice Address - Phone:540-434-1941
Practice Address - Fax:540-434-1791
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945336Medicaid
VAO82553MOtherSOUTHERN HEALTH