Individual
JODY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPA, LCAS, CCS
Contact information
Practice address
116 ELLIOTT DR, WILMINGTON, NC 28405-8433
(910) 623-0605
(910) 338-0495
Mailing address
PO BOX 4682, WILMINGTON, NC 28406-1682
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4690
NC
Other
Enumeration date
02/05/2015
Last updated
08/09/2022
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