Individual
CARRIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1213 COFFEE RD STE P, MODESTO, CA 95355-4229
(209) 527-8943
Mailing address
1428 HAZELNUT WAY, MANTECA, CA 95337-7916
(209) 603-4436
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ASW116754
CA
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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