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General NPI Number Information
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NPI Number | 1962398800
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Entity Type | Individual
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Provider Name | GENNA LAUREN LONG PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1180 STONECREST BLVD STE 101
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City | TEGA CAY
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State | SC
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Zip | 29708-6638
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Country | US
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Telephone | 803-372-8585
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Fax | 800-598-6601
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Provider Business Mailing Address
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Address Line | 1180 STONECREST BLVD STE 101
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City | TEGA CAY
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State | SC
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Zip | 29708-6638
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Country | US
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Telephone | 803-372-8585
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Fax | 800-598-6601
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 30508
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License Number State | SC
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