NPI | 1043525330 |
---|---|
Former Name | STACY NADINE LONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2011002074) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO none) |
Enumeration Date | 2010-08-11 |
Last Update Date | 2014-03-27 |