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1053047753
JONATHAN BRAXTON LONG
CONCORD, NC
NPI
1053047753
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: NC P016657)
Enumeration Date
2022-07-26
Last Update Date
2022-07-26
Business Address
JONATHAN BRAXTON LONG LCSW-A
280 EXECUTIVE PARK DR STE 100
CONCORD, NC 28025-1838
Phone number: 980-237-4766
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Mailing Address
JONATHAN BRAXTON LONG LCSW-A
4429 IYAR WAY
WAKE FOREST, NC 27587-4167
Phone number: 252-532-1320
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