Provider Demographics
NPI:1861244246
Name:LONG, KELLY (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 RENDANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2245
Mailing Address - Country:US
Mailing Address - Phone:912-704-6541
Mailing Address - Fax:
Practice Address - Street 1:221 EXECUTIVE CIR STE 4
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4529
Practice Address - Country:US
Practice Address - Phone:912-704-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health