Individual
CHARITY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
434 NE EVANS ST, MCMINNVILLE, OR 97128-4607
(503) 472-4022
Mailing address
1921 NW PENNY LN, MCMINNVILLE, OR 97128-6672
(971) 832-1216
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/13/2015
Last updated
01/13/2015
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