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Individual

MARSHELLE NIX LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4336 NORTH BLVD STE 204, BATON ROUGE, LA 70806-3920
(225) 960-7419
(225) 960-7421
Mailing address
2580 GILBERTS BCH, DOUGLASVILLE, GA 30135-8948
(816) 419-7055

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2203784617
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2203784617
LA
05
221S00000X
LA
05
251S00000X
LA
Enumeration date
08/08/2023
Last updated
08/08/2023
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