Individual
GENNA LAUREN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1180 STONECREST BLVD STE 101, TEGA CAY, SC 29708-6638
(803) 372-8585
(800) 598-6601
Mailing address
1180 STONECREST BLVD STE 101, TEGA CAY, SC 29708-6638
(803) 372-8585
(800) 598-6601
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
30508
SC
Other
Enumeration date
06/17/2025
Last updated
09/26/2025
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