Doctor Name: | CHARITY LONG |
NPI Number: | 1043609142 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 434 Ne Evans St Mcminnville, OR - 971284607 |
Business Phone Number: | 5034724022 |
Business Fax Number: | |
Mailing Address: | 1921 Nw Penny Ln, MCMINNVILLE |
State: | OR |
Postal Code: | 971286672 |
Phone Number: | 9718321216 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2015 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |