Individual
SHANNON LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4015 BELLE TERRE BLVD, MYRTLE BEACH, SC 29579-4917
(843) 410-8845
Mailing address
1293 PROFESSIONAL DR STE D222, MYRTLE BEACH, SC 29577-5754
(843) 333-2416
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
719396
SC
101YP2500X
Professional Counselor
6217
SC
Other
Enumeration date
11/01/2016
Last updated
09/08/2021
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