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General NPI Number Information
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NPI Number | 1306542402
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Entity Type | Individual
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Provider Name | CELSIE ANN LONG CSW
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 7300 S RAEFORD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-6162
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Country | US
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Telephone | 910-288-2120
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Fax |
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Provider Business Mailing Address
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Address Line | VA SALT LAKE CITY 500 FOOTHILL DR BLDG 16
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City | SALT LAKE CITY
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State | UT
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Zip | 84148-0001
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12278175-3502
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License Number State | UT
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