Provider Demographics
NPI:1700287273
Name:LONG, CASSIDI (LPCA)
Entity type:Individual
Prefix:
First Name:CASSIDI
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NORTH CAROLINA
Mailing Address - Zip Code:27407
Mailing Address - Country:UM
Mailing Address - Phone:704-654-5288
Mailing Address - Fax:
Practice Address - Street 1:1710 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8721
Practice Address - Country:US
Practice Address - Phone:336-395-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health