=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245319672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORNA A LONG M.S.,L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 12TH ST SUITE 222
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-3279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-232-4688
-----------------------------------------------------
Fax | 304-232-4682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 12TH ST SUITE 222
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-3279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-232-4688
-----------------------------------------------------
Fax | 304-232-4682
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CPOO812202
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------