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Individual
MR. BRADLEY DEAN LONG
Active
Individual
MR. BRADLEY DEAN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RASI
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RI-L1108311119
CA
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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