Charles Wilburn Long III, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1-141931 Issued in AL

Practice address

135 Gemini Cir
Birmingham, AL 35209-5842

Phone

(205) 201-0658

Fax

(205) 293-2270

NPI assigned

Feb 7, 2021

Last updated

Oct 6, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Birmingham Recovery Center Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Birmingham, AL
  • NPI 1134708597
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1912599309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 GEMINI CIR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352095842",
            "telephone_number": "205-201-0658",
            "fax_number": "205-293-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 GEMINI CIR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352095842",
            "telephone_number": "205-201-0658",
            "fax_number": "205-293-2270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 International Park Dr",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352434253",
            "country_code": "US",
            "telephone_number": "844-810-7340",
            "fax_number": "205-813-7405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "CHARLES",
        "middle_name": "WILBURN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-07",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "1-141931",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-141931",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby Long
• Alyssa Brooke Long, CRNP
• Caroline Bice Long, MCD, CCC-SLP
• Cassidy Long, BCBA
• Cecil Long, M.D.
• Crystal Long, D.C.
• Danelle Long
• Emily Stevens Long
• Gary Winn Long, MD
• Jalesa Symone Long, CRNP

• Psychiatric/Mental Health Nurse Practitioner in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.