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General NPI Number Information
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NPI Number | 1063033348
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Entity Type | Individual
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Provider Name | KIMBERLY LONG LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 10415 HICKORY PATH WAY STE 101
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City | KNOXVILLE
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State | TN
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Zip | 37922-0701
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Country | US
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Telephone | 865-671-1274
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Fax | 865-675-2003
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Provider Business Mailing Address
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Address Line | 9702 GROVE LAKE WAY UNIT 106
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City | KNOXVILLE
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State | TN
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Zip | 37922-5199
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Country | US
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Telephone | 865-924-7249
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Fax | 865-675-2003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8887
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7601
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License Number State | TN
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