Individual
MISS JUSTINA LOUISE DELONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
908 N REYNOLDS RD, BRYANT, AR 72022-3034
(501) 847-9711
(501) 847-6929
Mailing address
P.O. DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-65312
AR
106S00000X
Behavior Technician
RBT-19-99028
AR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207397706
—
AR
05
—
299960790
—
AR
Enumeration date
01/15/2014
Last updated
04/25/2023
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