Provider Demographics
NPI:1578181616
Name:LONG, PRINCESSA JEANETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:PRINCESSA
Middle Name:JEANETTE
Last Name:LONG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8433
Mailing Address - Country:US
Mailing Address - Phone:321-249-2712
Mailing Address - Fax:321-203-2512
Practice Address - Street 1:237 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8433
Practice Address - Country:US
Practice Address - Phone:321-249-2712
Practice Address - Fax:321-203-2512
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIHM18485101YM0800X
FLMH19769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health