Healthcare Provider Details

I. General information

NPI: 1245159763
Provider Name (Legal Business Name): JESSICA LONG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 GRINDER CREEK PL
CHATTANOOGA TN
37421-2746
US

IV. Provider business mailing address

8409 GRINDER CREEK PL
CHATTANOOGA TN
37421-2746
US

V. Phone/Fax

Practice location:
  • Phone: 478-361-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11738
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: