Provider Demographics
NPI:1831844737
Name:LONG, KRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 NORTHLAND LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4516
Mailing Address - Country:US
Mailing Address - Phone:815-608-2622
Mailing Address - Fax:
Practice Address - Street 1:120 E OGDEN AVE STE 125
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3767
Practice Address - Country:US
Practice Address - Phone:779-379-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor