Doctor Name: | LILA LONG |
NPI Number: | 1073990875 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 6010 Black Horse Pike Egg Harbor Township, NJ - 082349752 |
Business Phone Number: | 6096465142 |
Business Fax Number: | 6096457343 |
Mailing Address: | 6550 Delilah Rd, Suite 301 EGG HARBOR TOWNSHIP |
State: | NJ |
Postal Code: | 082345102 |
Phone Number: | 6092728580 |
Fax Number: | 6096457343 |
NPI Enumeration Date: | 04/30/2015 |
NPI Last Update Date: | 04/30/2015 |
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: |