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Individual
MICHEL LARAYNE LONG
Active
Individual
MICHEL LARAYNE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
8771
KS
1041C0700X
Clinical Social Worker
Primary
2015040067
MO
1041C0700X
Clinical Social Worker
SW13798
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200579430B
—
KS
Enumeration date
09/18/2013
Last updated
05/31/2022
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