Provider Demographics
NPI:1205961406
Name:LONG, LOUCINDA (LCSW)
Entity type:Individual
Prefix:
First Name:LOUCINDA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N WASHINGTON HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1326
Mailing Address - Country:US
Mailing Address - Phone:804-798-1335
Mailing Address - Fax:804-798-1909
Practice Address - Street 1:629 N WASHINGTON HWY
Practice Address - Street 2:SUITE F
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1326
Practice Address - Country:US
Practice Address - Phone:804-798-1335
Practice Address - Fax:804-798-1909
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker