Doctor Name: | TEKIA BILLETTE LONG |
NPI Number: | 1013372275 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, NCC, LPC |
License Number: | LPC008733 |
Business Practice Address: | 2580 Gilberts Bch Douglasville, GA - 301358948 |
Business Phone Number: | 2253410855 |
Business Fax Number: | |
Mailing Address: | 2580 Gilberts Bch, DOUGLASVILLE |
State: | GA |
Postal Code: | 301358948 |
Phone Number: | 2253410855 |
Fax Number: | |
NPI Enumeration Date: | 12/15/2015 |
NPI Last Update Date: | 12/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC008733 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |