Basic Information
Provider Information
NPI: 1003142142
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LONG
FirstName: ERIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 70 N MILLER RD
Address2:  
City: FAIRLAWN
State: OH
PostalCode: 443333702
CountryCode: US
TelephoneNumber: 3308670066
FaxNumber: 3398670056
Practice Location
Address1: 70 N MILLER RD
Address2:  
City: FAIRLAWN
State: OH
PostalCode: 443333702
CountryCode: US
TelephoneNumber: 3308670066
FaxNumber: 3398670056
Other Information
ProviderEnumerationDate: 10/25/2009
LastUpdateDate: 10/25/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XC 0700023OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home