Healthcare Provider Details

I. General information

NPI: 1346450616
Provider Name (Legal Business Name): CAROL A LONG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 TESSON FERRY RD STE 300
SAINT LOUIS MO
63123-6966
US

IV. Provider business mailing address

1048 CEDARGATE DR
SAINT LOUIS MO
63122-2427
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-0102
  • Fax: 314-842-2552
Mailing address:
  • Phone: 314-717-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004003782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: