Individual
MRS. LAKITA RENELL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
314 WOODS TRL, PERRY, GA 31069-9251
(478) 302-3135
Mailing address
PO BOX 8236, WARNER ROBINS, GA 31095-8236
(478) 302-3135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC006745
GA
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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