Provider Demographics
NPI:1225676927
Name:LONG, EREA (LCSW)
Entity type:Individual
Prefix:
First Name:EREA
Middle Name:
Last Name:LONG
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 CHRISTIAN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3239
Mailing Address - Country:US
Mailing Address - Phone:502-627-0377
Mailing Address - Fax:
Practice Address - Street 1:5630 CHRISTIAN RIDGE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3239
Practice Address - Country:US
Practice Address - Phone:502-627-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2598661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical