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General NPI Number Information
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NPI Number | 1508056045
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Entity Type | Individual
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Provider Name | GERI ANNE LONG CDP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 4800 COLLEGE ST SE
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City | LACEY
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State | WA
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Zip | 98503-4389
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Country | US
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Telephone | 509-990-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 14148 TILLEY RD S
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City | TENINO
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State | WA
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Zip | 98589-9222
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Country | US
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Telephone | 509-990-8775
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RC00054823
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60027739
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License Number State | WA
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