Provider Demographics
NPI:1083404560
Name:LONG, ELAINE YING
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:YING
Last Name:LONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6844
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-0844
Mailing Address - Country:US
Mailing Address - Phone:404-630-0943
Mailing Address - Fax:
Practice Address - Street 1:1758 COUNTY SERVICES PARKWAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008
Practice Address - Country:US
Practice Address - Phone:404-794-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0096031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical