Individual
JEANINE MICHELLE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 CHAPIN AVE, BURLINGAME, CA 94010-4062
(650) 348-6603
Mailing address
1450 CHAPIN AVE, BURLINGAME, CA 94010-4062
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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