| NPI | 1649620436 |
|---|---|
| Former Name | LISA MARIE LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-01-10993) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2024-06-18 |