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General NPI Number Information
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NPI Number | 1174716377
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Entity Type | Individual
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Provider Name | VICKIE LONGWILL LCDC, ADC III, ICADC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 2040 NORTH LOOP WEST SUITE 335
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City | HOUSTON
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State | TX
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Zip | 77018-8127
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Country | US
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Telephone | 713-628-2980
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Fax | 713-681-3800
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Provider Business Mailing Address
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Address Line | 2040 NORTH LOOP WEST SUITE 335
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City | HOUSTON
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State | TX
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Zip | 77018-8127
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Country | US
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Telephone | 713-628-2980
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Fax | 713-681-3800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2070
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License Number State | TX
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