Individual
SHELLY D LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1200 W WALNUT ST STE B1100, ROGERS, AR 72756-3562
(479) 278-7028
(479) 278-2092
Mailing address
PO BOX 679, MORRILTON, AR 72110-0679
(501) 354-4589
(501) 354-5410
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10293-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10293-M
SOCIAL WORK LICENSE
AR
Enumeration date
10/07/2021
Last updated
10/07/2021
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