Individual
NANCY MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
11287 MANCHESTER RD, SAINT LOUIS, MO 63122-1122
(314) 213-6100
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2008036364
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008036364
LPC
MO
Enumeration date
08/06/2018
Last updated
08/06/2018
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