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General NPI Number Information
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NPI Number | 1447841200
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Entity Type | Individual
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Provider Name | KIMBERLY ANN LONG LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 2944 PENN AVE
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City | MARIANNA
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State | FL
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Zip | 32448-2738
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Country | US
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Telephone | 526-550-0850
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Fax |
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Provider Business Mailing Address
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Address Line | 760 SPRING MEADOWS RD
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City | QUINCY
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State | FL
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Zip | 32351-7655
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Country | US
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Telephone | 850-557-2681
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH18792
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License Number State | FL
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