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1912322868
GREGORY LONG
GRAPEVINE, TX
NPI
1912322868
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TX 11080)
Enumeration Date
2014-03-02
Last Update Date
2014-03-02
Business Address
-- GREGORY LONG LCDC
1400 W NORTHWEST HWY 260
GRAPEVINE, TX 76051-8113
Phone number: 817-319-9962
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Mailing Address
-- GREGORY LONG LCDC
1400 W NORTHWEST HWY 260
GRAPEVINE, TX 76051-8113
Phone number: 817-319-9962
Copy
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