Doctor Name: | ERNESTINE LONG |
NPI Number: | 1053449124 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHP |
License Number: | |
Business Practice Address: | 225 E Main St Ste 300 Rock Hill, SC - 297304541 |
Business Phone Number: | 8033289600 |
Business Fax Number: | 8033297141 |
Mailing Address: | 524 Doctors Ct, CHESTER |
State: | SC |
Postal Code: | 297068644 |
Phone Number: | 8035818311 |
Fax Number: | 8033297141 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |