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General NPI Number Information
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NPI Number | 1093065278
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Entity Type | Individual
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Provider Name | LYDIA LONG LCSWA,LCAS
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 518 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2018
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Country | US
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Telephone | 336-209-0726
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Fax |
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Provider Business Mailing Address
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Address Line | 614 MORGAN COUNTRY RD
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City | ASHEBORO
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State | NC
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Zip | 27203-8342
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Country | US
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Telephone | 336-964-5565
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20732
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License Number State | NC
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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 | P008981
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License Number State | NC
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