Provider Demographics
NPI:1104612712
Name:NABORS, KACIE LONG (MS)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:LONG
Last Name:NABORS
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 N HAMILTON CIR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9762
Mailing Address - Country:US
Mailing Address - Phone:901-647-0950
Mailing Address - Fax:
Practice Address - Street 1:6800 POPLAR AVE STE 208
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7456
Practice Address - Country:US
Practice Address - Phone:901-515-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health