Individual
DR. STEPHANIE MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., MSCP, ABPP
Contact information
Practice address
3530 N COURTHOUSE RD, PROVIDENCE FORGE, VA 23140-3408
(804) 409-7525
(804) 315-9380
Mailing address
1731 UPLAND RD, WAXAHACHIE, TX 75165-1677
(804) 409-7525
(804) 315-9380
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
04975
MD
103TC0700X
Clinical Psychologist
Primary
810007571
VA
103TP0016X
Prescribing (Medical) Psychologist
311244
LA
Other
Enumeration date
12/19/2011
Last updated
05/06/2025
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