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General NPI Number Information
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NPI Number | 1245696558
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Entity Type | Individual
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Provider Name | AMY RENEE LONG LPC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 2406 CLEVELAND HWY SUITE 305
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City | DALTON
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State | GA
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Zip | 30721-8155
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Country | US
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Telephone | 706-277-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 FARLEY DR
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City | TUNNEL HILL
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State | GA
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Zip | 30755-7769
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Country | US
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Telephone | 423-802-9080
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007501
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License Number State | GA
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