Healthcare Provider Details

I. General information

NPI: 1376973255
Provider Name (Legal Business Name): SUSAN LEE LONG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EARLESTEAD DR
WALHALLA SC
29691-4009
US

IV. Provider business mailing address

215 EARLESTEAD DR
WALHALLA SC
29691-4009
US

V. Phone/Fax

Practice location:
  • Phone: 864-903-1038
  • Fax:
Mailing address:
  • Phone: 864-903-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: