Individual
TARA ELISE LONGMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LCAS-A
Contact information
Practice address
2018 FORT BRAGG RD # 124, FAYETTEVILLE, NC 28303-7037
(910) 485-3332
Mailing address
2018 FORT BRAGG RD # 124, FAYETTEVILLE, NC 28303-7037
(850) 376-4649
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-23175
NC
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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