| 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 |