MEDICARE: DANIELLE LONGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376346551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LONGO

Provider Business Mailing Address
First Line	:	113 BURKE CT APT 203
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-0439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 S KERR AVE STE 250
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-2573
Country	:	US
Telephone Number	:	843-212-6651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ DANIELLE LONGO ” Practice Location

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