Organization
LONG BRIDGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB BRADLEY LONG LCMHC, LPC, QS (CEO)
(336) 553-8147
Entity
Organization
Contact information
Practice address
149 GENE HILL RD, MOUNT AIRY, NC 27030-9072
(336) 553-8147
Mailing address
149 GENE HILL RD, MOUNT AIRY, NC 27030-9072
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/10/2025
Last updated
02/16/2025
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