Provider Demographics
NPI:1992956338
Name:LONG, LEANNE J (LPC, NCC)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:J
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MARK CENTER DR
Mailing Address - Street 2:14E08
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22350-2300
Mailing Address - Country:US
Mailing Address - Phone:571-372-5328
Mailing Address - Fax:
Practice Address - Street 1:4800 MARK CENTER DR
Practice Address - Street 2:14E08
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22350-2300
Practice Address - Country:US
Practice Address - Phone:571-372-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004468101YP2500X
AL867101YP2500X
TX20026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional