1740386481 NPI number — MS. MARY CATHARINE LONG MSW, LCSW

Table of content: MS. MARY CATHARINE LONG MSW, LCSW (NPI 1740386481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740386481 NPI number — MS. MARY CATHARINE LONG MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
MARY
Provider Middle Name:
CATHARINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUICHENEY
Provider Other First Name:
MARY
Provider Other Middle Name:
CATHARINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740386481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
583 J R PATE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-325-4388
Provider Business Mailing Address Fax Number:
704-331-0859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SKYVIEW CIR.
Provider Second Line Business Practice Location Address:
RHA BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-0894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15088 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".