Individual
LAURA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110B HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
(864) 360-9214
Mailing address
104 COTTON BAY WAY, SIMPSONVILLE, SC 29681-4374
(864) 360-9214
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4571
SC
Other
Enumeration date
09/30/2011
Last updated
12/01/2016
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