| NPI | 1588267157 |
|---|---|
| Former Name | CRYSTAL L LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61154536) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA CM60865562) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2021-06-07 |