Individual
JACOB LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
149 GENE HILL RD, MOUNT AIRY, NC 27030-9072
(336) 553-8147
Mailing address
149 GENE HILL RD, MOUNT AIRY, NC 27030-9072
(336) 553-8147
(336) 464-2376
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704005653
VA
101YP2500X
Professional Counselor
18420
VA
Other
Enumeration date
09/06/2022
Last updated
04/24/2023
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