Healthcare Provider Details

I. General information

NPI: 1285196196
Provider Name (Legal Business Name): EMMA TINSLEY-BOWLES LONG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ARMOR CT SW
BOLLING AFB DC
20032-7403
US

IV. Provider business mailing address

13 ARMOR CT SW
BOLLING AFB DC
20032-7403
US

V. Phone/Fax

Practice location:
  • Phone: 804-366-3033
  • Fax:
Mailing address:
  • Phone: 804-366-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010410
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: