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General NPI Number Information
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NPI Number | 1396387528
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Entity Type | Individual
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Provider Name | TERRI LONG LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 1208 E CHURCHVILLE RD STE 300
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City | BEL AIR
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State | MD
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Zip | 21014-3485
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Country | US
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Telephone | 410-893-4600
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Fax | 443-640-4358
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Provider Business Mailing Address
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Address Line | 7015 CONCORD RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-6004
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Country | US
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Telephone | 443-929-6393
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC11009
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License Number State | MD
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