Provider Demographics
NPI:1366722506
Name:LONG, DANISE E (PC,CDCA)
Entity type:Individual
Prefix:MRS
First Name:DANISE
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:PC,CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 FISHINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2108
Mailing Address - Country:US
Mailing Address - Phone:614-457-7876
Mailing Address - Fax:614-457-1040
Practice Address - Street 1:1560 FISHINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2108
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-1040
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1000192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health