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General NPI Number Information
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NPI Number | 1346450616
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Entity Type | Individual
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Provider Name | CAROL A LONG LPC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11166 TESSON FERRY RD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6966
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Country | US
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Telephone | 314-898-0102
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Fax | 314-842-2552
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Provider Business Mailing Address
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Address Line | 1048 CEDARGATE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63122-2427
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Country | US
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Telephone | 314-717-6998
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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 | 2004003782
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License Number State | MO
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