Healthcare Provider Details

I. General information

NPI: 1831450634
Provider Name (Legal Business Name): LENITA JOY LONG LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 WYCHE ST
HENDERSON NC
27536-4246
US

IV. Provider business mailing address

3210 FAIRHILL DR
RALEIGH NC
27612-3215
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-2581
  • Fax: 252-428-6364
Mailing address:
  • Phone: 919-256-0824
  • Fax: 919-256-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA9294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: