Individual
LISA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
502 FARRELL DR, COVINGTON, KY 41011-3717
(859) 466-7141
Mailing address
1792 FOREST RUN DR, INDEPENDENCE, KY 41051-8177
(859) 466-7141
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/23/2016
Last updated
06/10/2020
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